Jacobs David G, Sarafin Jennifer L, Head Karen E, Christmas A Britt, Huynh Toan, Miles William S, Sing Ronald E
F. H. Sammy Ross Trauma Institute, Carolinas Medical Center, Charlotte, North Carolina 28232, USA.
Am Surg. 2010 Jan;76(1):48-54.
Continuity of care is important in achieving optimal outcomes in trauma patients, but the optimal length of the trauma attending (TA) rotation is unknown. We hypothesize that longer TA rotations provide greater continuity, and therefore improve outcomes. We did a retrospective comparison of trauma patient outcomes from two consecutive 6-month periods during which we transitioned from a 1-month TA rotation to a 1-week TA rotation. The Wilcoxon rank sum test, and the chi2 were used for statistical analysis. Over the 12-month study period 1924 patients were admitted to the Trauma Service. The two groups were similar with regard to age, gender, injury mechanism, Injury Severity Score and Glasgow Coma Scale scores, and Abbreviated Injury Scores for the chest, abdomen, and extremities. Although mortality, patient charges, and violations of the standard of care were similar between the two groups, overall morbidity was lower (18.6% vs. 23.2%), and hospital length of stay higher (9.07 days vs. 8.41 days) in the 1-week TA group compared with the 1-month TA group. A one-week TA rotation was associated with a longer hospital length of stay, but improved morbidity. Longer TA rotations do not necessarily provide improved continuity or improved outcomes.
在创伤患者中实现最佳治疗效果时，连续性护理很重要，但创伤主治医生（TA）轮转的最佳时长尚不清楚。我们假设更长的TA轮转能提供更高的连续性，从而改善治疗效果。我们对创伤患者在两个连续6个月期间的治疗结果进行了回顾性比较，在此期间我们从1个月的TA轮转过渡到了1周的TA轮转。采用Wilcoxon秩和检验和卡方检验进行统计分析。在为期12个月的研究期间，1924名患者入住了创伤科。两组在年龄、性别、损伤机制、损伤严重程度评分、格拉斯哥昏迷量表评分以及胸部、腹部和四肢的简明损伤评分方面相似。尽管两组之间的死亡率、患者费用以及违反护理标准的情况相似，但与1个月TA组相比，1周TA组的总体发病率较低（18.6%对23.2%），住院时间较长（9.07天对8.41天）。1周的TA轮转与更长的住院时间相关，但发病率有所改善。更长的TA轮转不一定能提供更好的连续性或改善治疗效果。
