Kaplan Lewis J, Frankel Heidi Lee, Hojman Horacio, Portereiko Joseph, Rabinovici Reuven
Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
J Trauma. 2005 Aug;59(2):390-394. doi: 10.1097/01.ta.0000174729.48915.8e.
This study aims to determine the cost-benefit analysis of adding a full emergency general surgery (EGS) arm to a trauma/critical care (TCC) service with limited EGS activity in a Level I trauma center.
Data on the composition, activity, and billings of a TCC were collected and compared before (January 1, 2002-June 30, 2003) and after (July 1, 2003-December 31, 2003) it assumed the care of all unassigned EGS patients. These included patient volume and demographics, service, procedures, on-call/service activity, and professional billings and collections. Data are means +/- SD or percentages. Intergroup comparisons were performed by using t test or chi2 as appropriate; significance was assumed for values of p < 0.05.
Deploying an EGS arm increased coverage weeks (+52 weeks) and necessitated additional staffing (pre-EGS, n = 5; post-EGS, n = 6). Trauma operative volume remained constant (8.2 vs. 10.3 per month), EGS and elective case load increased (28.7 vs. 60 per month; p < 0.01), and the EGS case/consult ratio decreased from 0.81 to 0.64 (p < 0.01). This expanded activity was associated with reduced on-call nonclinical hours, from 3.2 +/- 0.9 to 1.1 +/- 0.8 (p < 0.01), and increased outpatient visits (68.6 vs. 91.1 per month; p < 0.01) and off-service time used for elective operations (22.3 vs. 76%; p < 0.01). Billings significantly increased in each arm compared with the pre-EGS study period (operating room, +44.8; intensive care unit, +12.5; outpatient, +48.7%; p < 0.01).
Integrating a full EGS into a TCC service encumbers increased nontrauma unscheduled clinical activity in the operating room, clinic, and floors, which resulted in enhanced billings. These beneficial effects were accrued at the expense of individual time and investment in recruiting additional faculty.
本研究旨在确定在一级创伤中心为急诊普通外科（EGS）活动有限的创伤/重症监护（TCC）服务增加完整的EGS部门的成本效益分析。
收集并比较了TCC在承担所有未分配的EGS患者护理之前（2002年1月1日至2003年6月30日）和之后（2003年7月1日至2003年12月31日）的组成、活动和计费数据。这些数据包括患者数量和人口统计学特征、服务、手术、随叫随到/服务活动以及专业计费和收款情况。数据以均值±标准差或百分比表示。组间比较根据情况使用t检验或卡方检验；p < 0.05的值被视为具有显著性。
增设一个EGS部门增加了覆盖周数（增加52周），并且需要额外的人员配备（EGS之前，n = 5；EGS之后，n = 6）。创伤手术量保持不变（每月8.2例对10.3例），EGS和择期病例量增加（每月28.7例对60例；p < 0.01），并且EGS病例/会诊比从0.81降至0.64（p < 0.01）。这种活动的扩展与随叫随到的非临床时间减少有关，从3.2±0.9小时降至1.1±0.8小时（p < 0.01），门诊就诊量增加（每月68.6例对91.1例；p < 0.01），以及用于择期手术的非服务时间增加（22.3%对76%；p < 0.01）。与EGS之前的研究期相比，每个部门的计费显著增加（手术室，+44.8%；重症监护病房，+12.5%；门诊，+48.7%；p < 0.01）。
将完整的EGS整合到TCC服务中会增加手术室、诊所和病房中非创伤性的非计划临床活动，这导致了计费增加。这些有益效果是以个人时间和招聘额外教职人员的投入为代价获得的。
