Podnos Y D, Wilson S E, Williams R A
Department of Surgery, University of California, Irvine College of Medicine, Orange 92668, USA.
Arch Surg. 1998 Aug;133(8):847-54. doi: 10.1001/archsurg.133.8.847.
To compare the effect of staffing with general surgeons vs trauma specialists on patient outcome at a trauma center.
The care of injured patients at a level I urban trauma center serving a population of 2.5 million was the responsibility of 12 surgeons (10 general surgeons and 2 trauma specialists) between January 1 and June 30, 1996 (group 1). Between July 1 and December 31, 1996 (group 2), trauma was the responsibility solely of 4 trauma specialists. An additional comparison was made with those patients in group 1 who were admitted to the general surgeons (group 1A). The outcomes and quality of care for these periods, as determined by the quality assurance screens, were retrospectively analyzed and compared.
Urban, tertiary care, level I trauma center.
Each trauma and burn patient admitted during the study periods is included in this study. Upon the patient's discharge from the hospital, specially trained nurses completed a review of the patient's stay and entered it into the TraumaOne database (Lancet Technology Inc, Cambridge, Mass). There were 693 trauma patients in group 1 (472 in group 1A) and 734 patients in group 2.
Mortality, length of stay, and 16 quality assurance screens were quantified and compared using chi(2) analyses and t tests.
The age and sex of the 2 groups were similar. The mortality rate was 6.2% (43/693) in group 1, 6.1% (29/472) in group 1A, and 6.5% (48/734) in group 2 (P = .80 and P = .78, respectively). When stratified by injury severity score (ISS), lengths of stay were statistically similar, except for patients with an ISS of 0 to 7. Patients with an ISS of 0 to 7 in groups 1 and 1A stayed a mean of 2.6 days, compared with 3.2 days for group 2 (P = .01 and P = .02, respectively). The results of quality assurance screens (missed injury, wound infection, readmission, and 13 others) were similar in the 2 groups.
Transitions in staffing afforded the opportunity to examine patient outcomes by surgeon specialization and frequency of call. In our sample, 12 well-trained surgeons taking call less frequently managed a trauma service as efficiently as a group of 4 trauma specialists, without any differences in morbidity and mortality.
比较在创伤中心配备普通外科医生与创伤专科医生对患者治疗结果的影响。
1996年1月1日至6月30日期间，在一个为250万人口服务的一级城市创伤中心，12名外科医生（10名普通外科医生和2名创伤专科医生）负责救治受伤患者（第1组）。1996年7月1日至12月31日期间（第2组），创伤救治工作仅由4名创伤专科医生负责。另外，将第1组中由普通外科医生收治的患者作为第1A组进行比较。通过质量保证筛查确定的这些时间段内的治疗结果和护理质量进行回顾性分析和比较。
城市三级甲等一级创伤中心。
本研究纳入了研究期间收治的每一位创伤和烧伤患者。患者出院时，经过专门培训的护士完成对患者住院情况的回顾，并将其录入TraumaOne数据库（马萨诸塞州剑桥市的柳叶刀技术公司）。第1组有693例创伤患者（第1A组有472例），第2组有734例患者。
使用卡方分析和t检验对死亡率、住院时间和16项质量保证筛查指标进行量化和比较。
两组患者的年龄和性别相似。第1组的死亡率为6.2%（43/693），第1A组为6.1%（29/472），第2组为6.5%（48/734）（P值分别为0.80和0.78）。按损伤严重程度评分（ISS）分层时，除ISS为0至7的患者外，住院时间在统计学上相似。第1组和第1A组中ISS为0至7的患者平均住院2.6天，而第2组为3.2天（P值分别为0.01和0.02）。两组质量保证筛查结果（漏诊损伤、伤口感染、再次入院及其他13项）相似。
人员配备的转变为按外科医生专业和值班频率检查患者治疗结果提供了机会。在我们的样本中，12名训练有素、值班频率较低的外科医生管理创伤服务的效率与4名创伤专科医生相当，发病率和死亡率没有差异。
