Davis Kimberly A, Cabbad Nicole C, Schuster Kevin M, Kaplan Lewis J, Carusone Carla, Leary Tucker, Udelsman Robert
Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies, Yale University School of Medicine, New Haven, Connecticut 06520-8062, USA.
J Trauma. 2008 Dec;65(6):1236-42; discussion 1242-4. doi: 10.1097/TA.0b013e31818ba311.
The purpose of this study was to determine whether trauma team oversight of patient management would positively affect efficiency of care as defined by improved patient throughput, with augmentation of both clinical and economic outcomes.
All patients activating the trauma team at a level I trauma center during two time periods (last 6 months of 2005 and 2006) were reviewed. Trauma team activation criteria remained constant across the two time periods. During period one, patients were admitted to multiple services depending on injury pattern, whereas in period two, most patients were admitted to the trauma service for trauma team oversight of their management. In period two, improved documentation and appropriate coding were encouraged. Data are reported as mean +/- SD, and median.
Patient demographics, number of full-time trauma surgeons, and payer mix were similar during the two time periods. Trauma activations increased 150% (p < 0.05). The percentage of patients admitted to the trauma service increased (68% vs. 86%, p < 0.001). Median injury severity score (ISS) of admitted patients was unchanged, although mean ISS decreased (15 +/- 15 vs. 12 +/- 11, p < 0.0001). Hospital length of stay decreased (12 +/- 55 vs. 6 +/- 11, p < 0.0001). Linear regression analysis identified ISS and admission during the later time period as significant predictors of decreased length of stay. Changes in billings and coding practices resulted in statistically significant increases in trauma surgeon work-related relative value units (182% increase), charges (360% increase), and collections (280% increase). The increased system efficiency resulted in significant decreases in the actual hospital costs per patient and led to the generation of an overall net positive hospital contribution margin per patient.
Implementation of trauma team oversight of patient care resulted in increased efficiency of care delivery, with shorter hospital lengths of stay despite increased patient volume. This paradigm change, coupled with improved documentation and coding, resulted in improved reimbursement for the physician, and lower cost per discharge for the hospital.
本研究的目的是确定创伤团队对患者管理的监督是否会对护理效率产生积极影响，护理效率的定义是提高患者周转率，并改善临床和经济结果。
回顾了在两个时间段（2005年和2006年的最后6个月）在一级创伤中心启动创伤团队的所有患者。两个时间段的创伤团队启动标准保持不变。在第一个时间段，患者根据损伤模式被收治到多个科室，而在第二个时间段，大多数患者被收治到创伤科室，接受创伤团队对其管理的监督。在第二个时间段，鼓励改进记录和进行适当编码。数据以平均值±标准差和中位数报告。
两个时间段的患者人口统计学特征、全职创伤外科医生数量和付款人组合相似。创伤启动增加了150%（p < 0.05）。收治到创伤科室的患者百分比增加（68%对86%，p < 0.001）。收治患者的中位损伤严重程度评分（ISS）未变，尽管平均ISS有所下降（15±15对12±11，p < 0.0001）。住院时间缩短（12±55对6±11，p < 0.0001）。线性回归分析确定后期的ISS和入院情况是住院时间缩短的重要预测因素。计费和编码方式的改变导致创伤外科医生与工作相关的相对价值单位有统计学显著增加（增加182%）、收费（增加360%）和收款（增加280%）。系统效率的提高导致每位患者的实际医院成本显著降低，并使每位患者产生总体净正医院贡献边际。
实施创伤团队对患者护理的监督提高了护理效率，尽管患者数量增加，但住院时间缩短。这种模式的改变，再加上改进的记录和编码，提高了医生的报销费用，并降低了医院每次出院的成本。
