The efficacy of a two-tiered trauma activation system at a level I trauma center.

BACKGROUND: By using current American College of Surgeons trauma center triage criteria, 52% of patients transported to our level I trauma center are discharged home from the emergency department (ED). Because the majority of our trauma transports were based solely on mechanism of injury, we instituted, in 1990, a two-tiered trauma team activation system. Patients are triaged into major and minor trauma alert categories based on prehospital provider information. For minor trauma patients, respiratory therapy, operating room staff, and blood bank do not respond. The current study evaluated this triage system. METHODS: Trauma registry data on all trauma activations from 1998 to 2007 were analyzed. RESULTS: There were 20,332 trauma activations: 5,881 were major trauma, 14,451 minor trauma. The mean Injury Severity Score in major versus minor patients was significantly different (11.7 vs. 3.6, p < 0.0001). Significant differences (p < 0.0001) were also noted for all other markers of serious injury: Injury Severity Score >16, ED blood pressure <90, Glasgow Coma Score

Trends in charges and payments for nonhospitalized emergency department pediatric visits, 1996-2003.

OBJECTIVES: To compare charges and payments for outpatient pediatric emergency visits across payer groups to provide information on reimbursement trends. METHODS: Total charges and payments for emergency department (ED) visits Medicaid/State Children's Health Insurance Program (SCHIP), privately insured, and uninsured pediatric patients from 1996 to 2003 using data from the Medical Expenditure Panel Survey. Average charges per visit and average payments per visit were also tracked, using regression analysis to adjust for changes in patient characteristics. RESULTS: While charges for pediatric ED visits rose over time, payments did not keep pace. This led to a decrease in reimbursement rates from 63% in 1996 to 48% in 2003. For all years, Medicaid/SCHIP visits had the lowest reimbursement rates, reaching 35% in 2003. The proportion of visits from children insured by Medicaid/SCHIP also increased over the period examined. In 2003, after adjustment, charges were $792 per visit from children covered by Medicaid/SCHIP, $913 for visits from uninsured children, and $952 for visits from privately insured children. CONCLUSIONS: Reimbursements for outpatient ED visits in the pediatric population have decreased from the period of 1996 to 2003 in all payer groups: public (Medicaid/SCHIP), private, and the uninsured. Medicaid/SCHIP has consistently paid less per visit than the privately insured and the uninsured. Further research on the effects of these declining reimbursements on the financial viability of ED services for children is warranted.