ABSTRACT
OBJECTIVE: Evaluate the influence of implementing the Oregon statewide trauma system on admission distribution and risk of death. DESIGN: Retrospective pre- and posttrauma system analyses of hospital discharge data regarding injured patients with one or more of the following injuries: head, chest, spleen/liver, pelvic fracture, and femur/tibia fracture. MATERIALS AND METHODS: Risk-adjusted odds ratio of admission to Level I or II (tertiary care) trauma centers, and odds ratio of death were determined using hospital discharge abstract data on 27,633 patients. Patients treated in 1985-1987, before trauma system establishment, were compared to patients treated in 1991-1993 after the trauma system was functioning. MEASUREMENTS AND MAIN RESULTS: After trauma system implementation, the odds ratio of admission to Level I or II trauma centers increased (odds ratio 2.36, 95% confidence interval 2.24-2.49). In addition, the odds ratio of death for injured patients declined after trauma system establishment (odds ratio 0.82, confidence interval 0.73-0.92). CONCLUSIONS: The Oregon trauma system was successfully implemented with more patients with index injuries admitted to hospitals judged most capable of managing trauma patients. The Oregon trauma system also appears beneficial since trauma system establishment is associated with a statewide reduction in risk of death.
Subject(s)
Hospitalization/statistics & numerical data , Regional Medical Programs , Trauma Centers , Wounds and Injuries/mortality , Abbreviated Injury Scale , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Injury Severity Score , Male , Middle Aged , Odds Ratio , Oregon/epidemiology , Retrospective Studies , Trauma Centers/organization & administration , Trauma Centers/statistics & numerical dataABSTRACT
OBJECTIVE: The goal of this study was to determine patient and injury characteristics that predict undertriage and overtriage. DESIGN: This study was a retrospective analysis of admissions for acute injury. MATERIALS AND METHODS: All admissions for acute injuries in a 2 1/2-year period were included (N = 26,025). ICD-9 clinical modification codes were converted to Injury Severity Scores. MAIN RESULTS: Seventy-nine percent of severely injured patients were admitted to level I trauma centers. Severely injured patients admitted to other hospitals (undertriage) were more likely elderly (odds ratio = 5.44) and less likely had multisystem injuries (odds ratio = 0.55). One-fourth of patients with minor injuries were admitted to level I trauma centers (overtriage). Overtriaged patients were more likely intoxicated, obese, or had an injury to the head or face. CONCLUSIONS: In a developed trauma system, severely injured elderly trauma patients (especially females) are at risk for undertriage. The characteristics of patients at risk for overtriage reflect the difficulties of prospective out-of-hospital triage.
Subject(s)
Triage/methods , Wounds and Injuries/classification , Adult , Aged , Emergency Medical Services/organization & administration , Female , Hospitalization , Humans , Length of Stay , Male , Middle Aged , Multivariate Analysis , Oregon , Retrospective Studies , Trauma Centers/statistics & numerical dataABSTRACT
In the competitive health care market of the 1990s, trauma centers face a multitude of fiscal challenges that threaten their survival. Trauma centers are confronted with the tremendous task of balancing the cost of caring for the patient with multiple trauma who requires resource-intensive care with the most fiscally responsible outcomes. Academic medical centers and residency training programs are faced with an even greater burden associated with controlling cost while providing learning experiences for physicians and nurses. Outcomes management represents the future strategy that trauma centers nationwide must embrace. Outcomes management gives trauma centers the opportunity to demonstrate their contribution to the community and society through improved patient and systems outcomes.
Subject(s)
Financial Management, Hospital , Outcome Assessment, Health Care , Trauma Centers/organization & administration , Forecasting , HumansABSTRACT
This article addresses the economic concerns associated with the development and maintenance of trauma centers. Information is presented to assist trauma center personnel to identify better their profit and loss status with trauma patients. Strategies are explored that may serve to improve reimbursement for trauma cases. Additional material is presented to assist in efforts to provide the most cost effective, high quality trauma care.
Subject(s)
Multiple Trauma/economics , Trauma Centers/economics , Cost-Benefit Analysis , Financial Management, Hospital , Health Care Costs , Humans , Multiple Trauma/therapy , Regional Medical Programs , Reimbursement MechanismsABSTRACT
OBJECTIVE: To determine if risk of death for hospitalized injured patients changes when an urban trauma system is implemented. DESIGN: An analysis of the risk of death in hospitalized injured patients in 1984 and 1985 (pretrauma system), 1986 and 1987 (early trauma system), and 1990 and 1991 (established trauma system) using hospital discharge abstract data. SETTING: A total of 18 acute care hospitals in the four-county area encompassing Portland, Ore. PATIENTS: A cohort of 70,350 hospitalized patients with at least one discharge diagnosis indicating injury. MAIN OUTCOME MEASURE: Death during hospitalization. RESULTS: After the trauma system was established, 77% of patients in the region with an Injury Severity Score (ISS) of 16 or greater were admitted to level I trauma centers. More than 72% of patients with an ISS less than 16 were hospitalized in nontrauma centers. Risk of death for injured patients hospitalized at level I trauma centers declined after the trauma system was established (odds ratio, 0.65; 95% confidence interval, 0.51 to 0.81). Patients who died in trauma centers after institution of the trauma system were younger and had more severe injuries, and the majority died within 1 day of admission, whereas patients who died in nontrauma centers died a median of 5 days after admission. CONCLUSION: Establishment of a trauma system shifted the more seriously injured patients to level I trauma centers, where there was a significant reduction in the adjusted death rate.
Subject(s)
Hospital Mortality , Regional Medical Programs , Trauma Centers/statistics & numerical data , Triage , Adolescent , Adult , Aged , Child , Child, Preschool , Comorbidity , Female , Humans , Infant , Logistic Models , Male , Middle Aged , Oregon/epidemiology , Outcome Assessment, Health Care , Survival Analysis , Trauma Centers/standards , Trauma Severity Indices , Triage/standards , Triage/statistics & numerical data , Urban HealthABSTRACT
With the passage of the COBRA transfer provisions, Congress has put hospitals on notice that patient dumping will no longer be tolerated. It is incumbent on hospitals to provide thorough guidelines of the COBRA requirements to its medical and nursing staff. The wise hospital administrator will ensure that comprehensive transfer procedures will be put into effect that are in accord with the COBRA provisions. Financial triage of patients in the emergency department could prove to be a costly problem for the hospital that misses an emergency condition.
