Lucas C E, Buechter K J, Coscia R L, Hurst J M, Meredith J W, Middleton J D, Rinker C R, Tuggle D, Vlahos A L, Wilberger J
Department of Surgery, Wayne State University, Detroit, MI, USA.
J Am Coll Surg. 2001 May;192(5):559-65. doi: 10.1016/s1072-7515(01)00829-8.
Level II trauma centers may be verified (1999, American College of Surgeons Committee on Trauma) with an on-call operating room team if the performance-improvement program shows no adverse outcomes. Using queuing and simulation methodology, this study attempted to add a volume guideline.
Data from 72 previously verified trauma centers identified multiple demographic factors, including specific information about the first trauma-related operation that was done between 11:00 PM and 7:00 AM each month for 12 consecutive months.
The annual admissions averaged 1,477 for 37 Level I trauma centers, 802 for 28 Level II trauma centers, 481 for 4 Level III trauma centers, and 731 for 3 pediatric trauma centers. The annual admissions correlated with the number of operations done between 11:00 PM and 7:00 AM (p < 0.001). These 946 operations were performed by general surgery (39%), neurosurgery (8%), orthopaedic surgery (33%), another specialty (9%), or multiple services (10%). Admission to operation time was within 30 minutes for 12.1% of patients (2.6% for blunt and 24.1% for penetrating injuries). The probability of operation within 30 minutes of arrival varied with the number of admissions and with the percentage of penetrating versus blunt injuries. The likely number of operations from 11:00 PM to 7:00 AM would be 19 for 500 annual admissions, 26 for 750 annual admissions, and 34 for 1,000 annual admissions, with 5.83, 7.98, and 10.13 patients, respectively, going to operation within 30 min. The probability that two rooms would be occupied simultaneously was 0.14 and 0.24 for centers admitting 500 and 1,000 patients, respectively.
Trauma centers performing fewer than six operations between 11:00 PM and 7:00 AM per year could conserve resources by using an immediately available on-call team, with responses monitored by the performance-improvement program.
如果绩效改进项目未显示出不良后果，二级创伤中心（1999年，美国外科医师学会创伤委员会）可通过随叫随到的手术室团队进行认证。本研究尝试使用排队和模拟方法添加一个容量指南。
来自72个先前已获认证的创伤中心的数据确定了多个人口统计学因素，包括关于连续12个月中每月晚上11点至早上7点之间进行的首例创伤相关手术的具体信息。
37个一级创伤中心的年入院平均人数为1477人，28个二级创伤中心为802人，4个三级创伤中心为481人，3个儿科创伤中心为731人。年入院人数与晚上11点至早上7点之间进行的手术数量相关（p < 0.001）。这946例手术由普通外科（39%）、神经外科（8%）、骨科（33%）、其他专科（9%）或多个科室（10%）实施。12.1%的患者入院至手术时间在30分钟内（钝性伤为2.6%，穿透伤为24.1%）。到达后30分钟内进行手术的概率随入院人数以及穿透伤与钝性伤的比例而变化。每年入院500人时，晚上11点至早上7点之间可能的手术数量为19例，每年入院750人时为26例，每年入院1000人时为34例，分别有5.83、7.98和10.13名患者在30分钟内接受手术。对于年入院500人和1000人的中心，两个手术室同时被占用的概率分别为0.14和0.24。
每年晚上11点至早上7点之间进行手术少于6例的创伤中心，可以通过使用随时可用的随叫随到团队来节省资源，并由绩效改进项目监测响应情况。
