Impact of adding Level II and III trauma centers on volume and disease severity at a nearby Level I trauma center.

BACKGROUND: As emergency care becomes increasingly regionalized, systems planners must determine how system expansion impacts existing system assets. We hypothesized that accrediting new Level II and III trauma centers impacted the trauma patient census and severity at a nearby Level I trauma center and estimated the magnitude of the impact. METHODS: We conducted an interrupted time series analysis using monthly patient counts during the past 10 years for five trauma centers located near one another in Pennsylvania. The Level I center (TC-A) operated for the entire period. A Level II center 39 miles away was accredited after 70 months (TC-B), one Level III center 46 miles away was accredited after 95 months but lost accreditation after 11 months (TC-C), and two other Level III centers 40 miles and 45 miles away were accredited after 107 months (TC-D and TC-E). RESULTS: Monthly patient volume at the Level I center, which increased gradually over the study and summed to 25,120 patients, decreased by 10.8% (p < 0.05) when TC-B was accredited and decreased by an additional 12.9% (p < 0.05) when TC-D and TC-E were accredited simultaneously. No change stemmed from temporarily accrediting TC-C. Ultimately, the Level I center treated 1,903 fewer patients than expected over 51 months, an 11.9% volume reduction, and patient severity remained consistent but mortality decreased. CONCLUSION: Accrediting Level II and Level III trauma centers reduced patient volume and reduced overall mortality at a nearby Level I center. Strategic planning of statewide trauma systems can help balance rapid access to care with maintenance of adequate annual patient volumes of critically injured patients. LEVEL OF EVIDENCE: Epidemiologic study, Level IV.

Weekend and night outcomes in a statewide trauma system.

OBJECTIVE: To evaluate whether mortality and clinical outcomes vary for injured patients in a mature trauma system on weeknights and weekends compared with weekdays. DESIGN: Retrospective cohort study. SETTING: Pennsylvania trauma system. PATIENTS: A total of 90,461 patients over 5 years. INTERVENTION: Treatment at a level I, II, or III trauma center. MAIN OUTCOME MEASURES: In-hospital mortality, time to procedures, and length of stay. RESULTS: In adjusted analyses, patients presenting on weeknights were no more likely to die than patients presenting during weekdays, and patients presenting on weekends were less likely to die than patients presenting on weekdays (odds ratio = 0.89; 95% confidence interval, 0.81-0.97). Presenting on weeknights was associated with longer intensive care unit stay (incidence rate ratio = 1.06; 95% confidence interval, 1.02-1.10) and longer hospital stay (incidence rate ratio = 1.02; 95% confidence interval, 1.00-1.04). Presenting on weekends was associated with longer intensive care unit stay (incidence rate ratio = 1.04; 95% confidence interval, 1.02-1.10) but not longer hospital stay. Delays to laparotomy or craniotomy were not seen in either group. CONCLUSIONS: We demonstrate comparable mortality among injured patients presenting on weeknights vs weekdays and lower mortality among injured patients on weekends vs weekdays. Systems-based solutions of the trauma model are protective against the weekend effect and inform care for other emergency care-sensitive conditions.

When West meets East: the experience of the Society of Trauma Nurses' Nursing delegation's visit to China with the People to People Citizen Ambassador Program.

In October 2008, 39 nurses traveled to China as part of the People to People Citizen Ambassador Program Emergency and Trauma Nursing delegation. The group compared and contrasted emergency and trauma nursing practices in the United States with those in China. Similarities include the methods of nursing education, the focus on patient and family education, and the passion of the nurses for delivering optimal care to their patients. Differences include the Chinese nurse's use of traditional Chinese medicine, the lack of modern technology, and low wages of healthcare personnel. The trip emphasized to the delegation the imperative for all nurses, regardless of their location in the world to reach out to one another to share best practices and their love of nursing.