LENGTH OF STAY AND TRAUMA CENTER FINANCES

2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Marin A. Chavez ◽  
James N. Bogert ◽  
Hahn Soe-Lin ◽  
Jordan V. Jacobs ◽  
Kristina M. Chapple ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Trauma Center

scholarly journals Is it a matter of time? The effect of transfer time on femur fracture outcomes

2021 ◽  
Vol 6 (1) ◽  
pp. e000701
Author(s):  
Leah E Larson ◽  
Melissa L Harry ◽  
Paul K Kosmatka ◽  
Kristin P Colling
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Femur Fracture ◽  
Fracture Repair ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Transfer Time ◽  
Femur Fractures ◽  
Initial Hospital ◽  
Level 1

BackgroundTrauma systems in rural areas often require longdistance transfers for definitive care. Delays in care, such as delayed femurfracture repair have been reported to be associated with poorer outcomes, butlittle is known about how transfer time affects time to repair or outcomesafter femur fractures.MethodsWe conducted a retrospective review of all trauma patients transferred to our level 1 rural trauma center between May 1, 2016-April 30, 2019. Patient demographics and outcomes were abstracted from chart and trauma registry review. All patients with femur fractures were identified. Transfer time was defined as the time from admission at the initial hospital to admission at the trauma center, and time to repair was defined as time from admission to the trauma center until operative start time. Our outcome variables were mortality, in-hospital complications, and hospital length of stay (LOS).ResultsOver the study period1,887 patients were transferred to our level 1 trauma center and 398 had afemur fracture. Compared to the entire transfer cohort, femur fracture patientswere older (71 versus 57 years), and more likely to be female (62% versus 43%).The majority (74%) of patients underwent fracture repair within 24hours. Delay in fracture fixation >24 hours wasassociated with increased length of stay (5 days versus 4 days; p<0.001),higher complication rates (23% versus 12%; p=0.01), and decreased dischargehome (19% vs. 32%, pp=0.02), but was not associated with mortality (6% versus5%; p=0.75). Transfer time and time at the initial hospital were not associatedwith mortality, complication rate, or time to femur fixation.DiscussionFixation delay greater than 24 hours associated with increased likelihood of in-hospital complications, longer length of stay, and decreased likelihood of dischargehome. Transfer time not related to patient outcomes or time to femur fixation.Level of evidenceLevel III; therapeutic/care management.

scholarly journals Does emergency medicine length of stay predict trauma outcomes at a Level 1 Trauma Center?

2015 ◽  
Vol 4 (5) ◽  
pp. 1 ◽  
Author(s):  
Erin Powers Kinney ◽  
Kamal Gursahani ◽  
Eric Armbrecht ◽  
Preeti Dalawari
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Hospital Capacity ◽  
Significant Difference ◽  
Level 1 ◽  
Level 1 Trauma Center

Objective: Previous studies looking at emergency department (ED) crowding and delays of care on outcome measures for certain medical and surgical patients excluded trauma patients. The objectives of this study were to assess the relationship of trauma patients’ ED length of stay (EDLOS) on hospital length of stay (HLOS) and on mortality; and to examine the association of ED and hospital capacity on EDLOS.Methods: This was a retrospective database review of Level 1 and 2 trauma patients at a single site Level 1 Trauma Center in the Midwest over a one year period. Out of a sample of 1,492, there were 1,207 patients in the analysis after exclusions. The main outcome was the difference in hospital mortality by EDLOS group (short was less than 4 hours vs. long, greater than 4 hours). HLOS was compared by EDLOS group, stratified by Trauma Injury Severity Score (TRISS) category (< 0.5, 0.51-0.89, > 0.9) to describe the association between ED and hospital capacity on EDLOS.Results: There was no significant difference in mortality by EDLOS (4.8% short and 4% long, p = .5). There was no significant difference in HLOS between EDLOS, when adjusted for TRISS. ED census did not affect EDLOS (p = .59), however; EDLOS was longer when the percentage of staffed hospital beds available was lower (p < .001).Conclusions: While hospital overcrowding did increase EDLOS, there was no association between EDLOS and mortality or HLOS in leveled trauma patients at this institution.

scholarly journals Early Psychiatric Consultation Is Associated With Decreased Cost and Length of Stay in the Patient Population at a Level I Trauma Center

Cureus ◽  
2021 ◽  
Author(s):  
Marin A Chavez ◽  
Jason P Caplan ◽  
Curtis A McKnight ◽  
Andrew B Schlinkert ◽  
Kristina M Chapple ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Population ◽  
Trauma Center ◽  
Psychiatric Consultation ◽  
Level I

Experience in an Urban Level 1 Trauma Center With Tranexamic Acid in Pediatric Trauma: A Retrospective Chart Review

2020 ◽  
pp. 088506661989083
Author(s):  
Julie M. Thomson ◽  
Hanh H. Huynh ◽  
Holly M. Drone ◽  
Jessica L. Jantzer ◽  
Albert K. Tsai ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Tranexamic Acid ◽  
Trauma Center ◽  
Surgical Intervention ◽  
Statistical Significance ◽  
Pediatric Trauma ◽  
End Points ◽  
Transfusion Requirements ◽  
Level 1 ◽  
Level 1 Trauma Center

Background: Evidence for tranexamic acid (TXA) in the pharmacologic management of trauma is largely derived from data in adults. Guidance on the use of TXA in pediatric patients comes from studies evaluating its use in cardiac and orthopedic surgery. There is minimal data describing TXA safety and efficacy in pediatric trauma. The purpose of this study is to describe the use of TXA in the management of pediatric trauma and to evaluate its efficacy and safety end points. Methods: This retrospective, observational analysis of pediatric trauma admissions at Hennepin County Medical Center from August 2011 to March 2019 compares patients who did and did not receive TXA. The primary end point is survival to hospital discharge. Secondary end points include surgical intervention, transfusion requirements, length of stay, thrombosis, and TXA dose administered. Results: There were 48 patients aged ≤16 years identified for inclusion using a massive transfusion protocol order. Twenty-nine (60%) patients received TXA. Baseline characteristics and results are presented as median (interquartile range) unless otherwise specified, with statistical significance defined as P < .05. Patients receiving TXA were more likely to be older, but there was no difference in injury type or Injury Severity Score at baseline. There was no difference in survival to discharge or thrombosis. Patients who did not receive TXA had numerically more frequent surgical intervention and longer length of stay, but these did not reach significance. Conclusions: TXA was utilized in 60% of pediatric trauma admissions at a single level 1 trauma center, more commonly in older patients. Although limited by observational design, we found patients receiving TXA had no difference in mortality or thrombosis.

Trauma Center Finances and Length of Stay: Identifying a Profitability Inflection Point

2010 ◽  
Vol 210 (5) ◽  
pp. 817-821 ◽  
Author(s):  
Samir M. Fakhry ◽  
Debbie Couillard ◽  
Casey T. Liddy ◽  
David Adams ◽  
E. Douglass Norcross
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Inflection Point

mma-1. A Length-of-Stay Analysis of a Level I Urban Trauma Center

2003 ◽  
Vol 96 (Supplement) ◽  
pp. S57
Author(s):  
Robert G. Kayser ◽  
Bartholomew J. Tortella
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Level I

The Affordable Care Act and its association with length of stay and payer status for trauma patients at a level I trauma center

2017 ◽  
Vol 213 (5) ◽  
pp. 870-873 ◽  
Author(s):  
Vicente Jose Undurraga Perl ◽  
Chris Dodgion ◽  
Kyle Hart ◽  
Bruce Ham ◽  
Martin Schreiber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Affordable Care Act ◽  
Trauma Center ◽  
Trauma Patients ◽  
The Affordable Care Act ◽  
Level I

Staff Commitment to Trauma Care Improves Mortality and Length of Stay at a Level I Trauma Center

2009 ◽  
Vol 66 (5) ◽  
pp. 1315-1320 ◽  
Author(s):  
Charles Mains ◽  
Kristin Scarborough ◽  
Raphael Bar-Or ◽  
Allison Hawkes ◽  
Jeffery Huber ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Trauma Care ◽  
Trauma Center ◽  
Level I ◽  
Staff Commitment

A Handoff Protocol for Pediatric Trauma Patients at a Rural Level One Trauma Center Reduces Length of Stay

2020 ◽  
pp. 000313482095633
Author(s):  
Evelyn Coile ◽  
Kathryn Bailey ◽  
Eric J. Clayton ◽  
Tatiana R. Eversley Kelso ◽  
Heather MacNew
Keyword(s):  
Length Of Stay ◽  
Trauma Center ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Before And After ◽  
Ancillary Staff ◽  
Trauma Triage ◽  
Level 1 ◽  
Trauma Surgeons ◽  
Level 1 Trauma Center

Background The management of the pediatric trauma patient is variable among trauma centers. In some institutions, the trauma surgeon maintains control of the patient throughout the hospital stay, while others transfer to a pediatric specialist after the initial evaluation and resuscitation period. We hypothesized that handoff to the pediatric surgeon would decrease the length of stay by more efficient coordination with pediatric subspecialists and ancillary staff. Methods A retrospective review from October 2014 to October 2018 was conducted at our rural level 1 trauma center analyzing the length of stay across all demographics and trauma triage levels before and after institution of a handoff protocol from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window. Further analysis included emergency department (ED) disposition to include the effect of handoff on the length of stay in the setting of a higher post-ED acuity, that is, disposition of monitored beds. Results 1267 patient charts were analyzed and the mean length of stay was reduced by .38 days ( t = 5.92, P < .0005) across all demographics, trauma triage levels, post-ED dispositions, and mechanisms of injury after institution of our handoff protocol. Conclusion Handoff from adult specialized trauma surgeons to pediatric surgeons within a 24-hour window at a rural level 1 trauma center significantly improved the length of stay by .38 ( t = 5.92, P < .0005) among pediatric trauma patients in all demographics, trauma triage activations levels, mechanisms of injury, and post-ED dispositions acuity levels.

scholarly journals The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center

2021 ◽  
Vol 18 (16) ◽  
pp. 8542
Author(s):  
Husham Abdelrahman ◽  
Hassan Al-Thani ◽  
Naushad Ahmad Khan ◽  
Monira Mollazehi ◽  
Mohammad Asim ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Trauma Center ◽  
Injury Severity ◽  
Working Hours ◽  
Seasonal Effect ◽  
Rehabilitation Centers ◽  
Demographic Effect ◽  
Significant Seasonal Variation ◽  
Level 1

Background: The trauma incidence follows specific patterns in different societies and is expected to increase over the weekend and nighttime. We aimed to explore and analyze the incidence, pattern, and severity of trauma at different times (working hours vs. out off-working hours, weekdays vs. weekends and season). Methods: A retrospective analysis was conducted at a level 1 trauma facility in Qatar. All injured patients admitted between June 2017 and May 2018 were included. The data were analyzed to determine whether outcomes and care parameters of these patients differed between regular working hours and off-working hours, weekdays vs. weekends, and between season intervals. Results: During the study period, 2477 patients were admitted. A total of 816 (32.9%) patients presented during working hours and 1500 (60.6%) during off-working hours. Off-working hours presentations differed significantly with the injury severity score (ISS) (p  <  0.001), ICU length of stay (p  =  0.001), blood transfusions (p = 0.001), intubations (p = 0.001), mortality rate (9.7% vs. 0.7%; p < 0.001), and disposition to rehabilitation centers. Weekend presentations were significantly associated with a higher ISS (p = 0.01), Priority 1 trauma activation (19.1% vs. 14.7%; p = 0005), and need for intubation (21% vs. 16%; p = 0.002). The length of stay (ICU and hospital), mortality, and disposition to rehabilitation centers and other clinical parameters did not show any significant differences. No significant seasonal variation was observed in terms of admissions at the trauma center. Conclusions: The off-working hours admission showed an apparent demographic effect in involved mechanisms, injury severity, and trauma activations, while outcomes, especially the mortality rate, were significantly different during nights but not during the weekends. The only observed seasonal effect was a decrease in the number of admissions during the summer break.

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