Francis Andrew A, Wall Joyce E M, Stone Andrew, Dewane Michael P, Dyke Ann, Gregg Shea C
Department of Surgery, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA.
J Emerg Trauma Shock. 2020 Oct-Dec;13(4):286-295. doi: 10.4103/JETS.JETS_151_19. Epub 2020 Dec 7.
The current growth of the geriatric population and increased burden on trauma services throughout the United States (US) has created a need for systems that can improve patient care and reduce hospital costs. We hypothesize that the multidisciplinary services provided through the Geriatric Injury Institute (GII) can reduce hospital costs, improve patient triage throughput, and decrease hospital length of stay (LOS).
We performed a single-center, retrospective chart review of our Level II trauma center registry and electronic medical records of patients ages 65 and older who satisfied trauma activation/code criteria between July 1, 2014, to June 30, 2016 ( = 663). Patients presenting from July 1, 2014, to June 30, 2015, were grouped as Pre-GII, while those presenting from July 1, 2015, to June 30, 2016, were grouped as Post-GII. Primary outcomes were emergency department (ED) triage time, overall LOS, and hospital costs. Secondary outcomes included patient disposition, mortality, and health assessments. Statistical comparisons were made using a one-way analysis of variance and Mann-Whitney U test.
Pre-GII vs. Post-GII average ages and the Injury Severity Score (ISS) were not statistically different (>0.05). The average LOS was similar between the Pre-GII and Post-GII groups (4.64 ± 4.42 days vs. 4.26 ± 5.58 days, = 0.48). More patients were discharged earlier (≤ 4 days; 64% vs. 73%) as well as discharged to home (37% vs. 45%) in the Post-GII group. The total cost savings were $53,000 with a median savings of $1061 per patient ($8808 vs. $7747, = 0.04). Savings were highest during the first two days of admission ( = 0.03). The reduction in ED triage time was not significant (310.7 minutes vs 219. 8 minutes, > 0.05).
With the increase in geriatric trauma, innovative models of care are needed. Our study suggests that the GII multidisciplinary approach to trauma services can lower overall hospital costs.
美国老年人口的不断增长以及创伤服务负担的加重，使得需要有能够改善患者护理并降低医院成本的系统。我们假设通过老年创伤研究所（GII）提供的多学科服务可以降低医院成本、改善患者分诊流程并缩短住院时间（LOS）。
我们对二级创伤中心登记处以及2014年7月1日至2016年6月30日期间符合创伤激活/编码标准的65岁及以上患者的电子病历进行了单中心回顾性图表审查（n = 663）。2014年7月1日至2015年6月30日期间就诊的患者归为GII前组，而2015年7月1日至2016年6月30日期间就诊的患者归为GII后组。主要结局为急诊科（ED）分诊时间、总体住院时间和医院成本。次要结局包括患者处置情况、死亡率和健康评估。采用单因素方差分析和曼-惠特尼U检验进行统计学比较。
GII前组与GII后组的平均年龄和损伤严重程度评分（ISS）无统计学差异（P>0.05）。GII前组和GII后组的平均住院时间相似（4.64±4.42天对4.26±5.58天，P = 0.48）。GII后组更多患者更早出院（≤4天；64%对73%）以及出院回家（37%对45%）。总成本节省了53,000美元，每位患者的中位数节省为1061美元（8808美元对7747美元，P = 0.04）。入院前两天的节省最为显著（P = 0.03）。ED分诊时间的缩短不显著（310.7分钟对219.8分钟，P>0.05）。
随着老年创伤患者的增加，需要创新的护理模式。我们的研究表明，GII对创伤服务采用的多学科方法可以降低总体医院成本。
