title: Early Appropriate Care: A Protocol to Standardize Resuscitation Assessment and to Expedite Fracture Care Reduces Hospital Stay and Enhances Revenue.
abstract: OBJECTIVE
  We hypothesized that a standardized protocol for fracture care would enhance revenue by reducing complications and length of stay.
  
  
  METHODS
  Prospective consecutive series.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  Two hundread and fifty-three adult patients with a mean age of 40.7 years and mean Injury Severity Score of 26.0.
  
  
  METHODS
  Femur, pelvis, or spine fractures treated surgically.
  
  
  METHODS
  Hospital and professional charges and collections were analyzed. Fixation was defined as early (<36 hours) or delayed. Complications and hospital stay were recorded.
  
  
  RESULTS
  Mean charges were US $180,145 with a mean of US $66,871 collected (37%). The revenue multiplier was US $59,882/$6989 (8.57), indicating hospital collection of US $8.57 for every professional dollar, less than half of which went to orthopaedic surgeons. Delayed fracture care was associated with more intensive care unit (4.5 vs. 9.4) and total hospital days (9.4 vs. 15.3), with mean loss of actual revenue US $6380/patient delayed (n = 47), because of the costs of longer length of stay. Complications were associated with the highest expenses: mean of US $291,846 charges and US $101,005 collections, with facility collections decreased by 5.1%. An uncomplicated course of care was associated with the most favorable total collections: (US $60,017/$158,454 = 38%) and the shortest mean stay (8.7 days).
  
  
  CONCLUSIONS
  Facility collections were nearly 9 times more than professional collections. Delayed fixation was associated with more complications, and facility collections decreased 5% with a complication. Furthermore, delayed fixation was associated with longer hospital stay, accounting for US $300K more in actual costs during the study. A standardized protocol to expedite definitive fixation enhances the profitability of the trauma service line.
  
  
  METHODS
  Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Vallier
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Dolenc
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Moore
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005264:Femoral Fractures / Q000191:economics / Q000601:surgery; D005592:Fracture Fixation / Q000191:economics / Q000592:standards; D050723:Fractures, Bone / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy; D010384:Pelvic Bones / Q000293:injuries / Q000601:surgery; D011446:Prospective Studies; D012151:Resuscitation / Q000191:economics* / Q000401:mortality / Q000592:standards; D012307:Risk Factors; D016103:Spinal Fractures / Q000191:economics / Q000601:surgery; D014193:Trauma Centers / Q000191:economics