scholarly journals Trauma center funding: time for an update

2021 ◽  
Vol 6 (1) ◽  
pp. e000596
Author(s):  
Heather M Grossman Verner ◽  
Brian A Figueroa ◽  
Marcos Salgado Crespo ◽  
Manuel Lorenzo ◽  
Joseph D Amos
Keyword(s):  
Patient Care ◽  
Trauma Care ◽  
Statistical Significance ◽  
Pairwise Comparison ◽  
Steady Increase ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Trauma Service ◽  
The Usa ◽  
Level I

BackgroundUncompensated care (UC) is healthcare provided with no payment from the patient or an insurance provider. UC directly contributes to escalating healthcare costs in the USA and potentially impacts patient care. In Texas, there has been a steady increase in the number of trauma centers and UC volumes without an increase in trauma funding of UC. The method of calculating UC trauma funds in Texas is imprecise as it is driven by Medicaid volumes and not actual trauma care costs.MethodsFive years of annual trauma UC disbursement reports from the Texas Department of State Health Services were used to determine changes in UC economic considerations for level I, II, and III trauma centers in the largest urban trauma service areas (TSAs). Data for UC costs, compensation, and TSA demographics were used to assess variations. Statistical significance was determined using a Kruskal-Wallis test with Dunn’s pairwise comparison post-hoc analysis and logistic regression.ResultsTSA-E (Dallas-Fort Worth area) has 33% of the level I trauma centers in Texas (n=6) and yet serves only 27% of the total state population across 14 metropolitan and 5 non-metropolitan counties. Since 2015, TSA-E has shown higher UC costs (p<0.02) and lower reimbursement (p<0.01) than the second largest urban hub, TSA-Q (Houston area). TSA-E level I trauma centers trended towards decreased UC reimbursements.DiscussionThe unregulated expansion of trauma centers in Texas has led to an unprecedented increase in hospitals participating in trauma care. The unbalanced allocation of UC funding could lead to further economic instability, compromise resource allocation, and negatively impact patient care in an already fragile healthcare environment.Level of evidenceLevel IV; Retrospective economic analysis and evaluation.

scholarly journals Effect of the COVID-19 pandemic on the ability of level 1 trauma centers to meet American College of Surgeons research requirements

2021 ◽  
Vol 6 (1) ◽  
pp. e000692
Author(s):  
Robert M Madayag ◽  
Erica Sercy ◽  
Gina M Berg ◽  
Kaysie L Banton ◽  
Matthew Carrick ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Trauma Centers ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
American College Of Surgeons ◽  
The Usa ◽  
Virus Exposure ◽  
Level 1 ◽  
Verification Process ◽  
Question Survey

IntroductionThe COVID-19 pandemic has had major effects on hospitals’ ability to perform scientific research while providing patient care and minimizing virus exposure and spread. Many non-COVID-19 research has been halted, and funding has been diverted to COVID-19 research and away from other areas.MethodsA 28-question survey was administered to all level 1 trauma centers in the USA that included questions about how the pandemic affected the trauma centers’ ability to fulfill the volume and research requirements of level 1 verification by the American College of Surgeons (ACS).ResultsThe survey had a 29% response rate (40/137 successful invitations). Over half of respondents (52%) reported reduced trauma admissions during the pandemic, and 7% reported that their admissions dropped below the volume required for level 1 verification. Many centers diverted resources from research during the pandemic (44%), halted ongoing consenting studies (33%), and had difficulty fulfilling research requirements because of competing clinical priorities (40%).DiscussionResults of this study show a need for flexibility in the ACS verification process during the COVID-19 pandemic, potentially including reduction of the required admissions and/or research publication volumes.Level of evidenceLevel IV, cross-sectional study.

scholarly journals The TEAM (Trauma Evaluation and Management) course: medical student knowledge gains and retention in the USA versus Ghana

2019 ◽  
Vol 4 (1) ◽  
pp. e000287 ◽  
Author(s):  
Allison E Berndtson ◽  
Martin Morna ◽  
Samuel Debrah ◽  
Raul Coimbra
Keyword(s):  
Trauma Care ◽  
Level Of Evidence ◽  
Middle Income ◽  
Institutional Review ◽  
Knowledge Deficit ◽  
Life Years ◽  
Before And After ◽  
The Usa ◽  
Knowledge Gains ◽  
The Impact

IntroductionTrauma and injury are significant contributors to the global burden of disease, with 5 million deaths and 250 million disability-adjusted life years lost in 2015. This burden is disproportionally borne by low- and middle-income countries (LMICs). Solutions are complex, but one area for improvement is basic trauma education. The American College of Surgeons has developed the Trauma Evaluation and Management (TEAM) course as an introduction to trauma care for medical students. We hypothesized that the TEAM course would be an effective educational program in LMICs and result in increased knowledge gains and retention similar to students in high-income countries (HICs).MethodsThe TEAM course was taught and students evaluated at two sites, one LMIC (Ghana) and one HIC (USA), after obtaining approval from the HIC Institutional Review Board and medical schools at both sites. Participation was optional for all students and results were de-identified. The course was administered by a single educator for all sessions. Multiple-choice exams were given before and after the course, and again 6 months later.ResultsA total of 62 LMIC and 64 HIC students participated in the course and completed initial testing. Demographics for the two groups were similar, as was participant attrition over time. LMIC students started with a relative knowledge deficit, scoring lower on both pre-course and post-course tests than HIC students, but gained more knowledge during the initial teaching session. After 6 months, the LMIC students continued to improve, whereas the HIC students’ knowledge had regressed. Most students recommended course expansion.ConclusionThe TEAM course is a useful tool to provide the basic principles of trauma care to students in LMICs, and should be expanded. Further study is needed to determine the impact of TEAM education on patient care in LMICs.Level of evidenceLevel III; Care Management

scholarly journals Examining trends in gun violence injuries before and during the COVID-19 pandemic across six trauma centers

2022 ◽  
Vol 7 (1) ◽  
pp. e000801
Author(s):  
Constance McGraw ◽  
Stephanie Jarvis ◽  
Matthew Carrick ◽  
Mark Lieser ◽  
Robert M Madayag ◽  
...  
Keyword(s):  
Mental Illness ◽  
Substance Use ◽  
Trauma Centers ◽  
National Guidelines ◽  
Level Of Evidence ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Level I ◽  
The Impact ◽  
At Home

ObjectivesThe onset of the national stay-at-home orders accompanied by a surge in firearm sales has elevated the concerns of clinicians and public health authorities. The purpose of this study was to examine the impact of the stay-at-home orders among gunshot wound (GSW) trauma admissions.MethodsThis was a retrospective cohort study at six level I trauma centers across four states. Patients admitted after the onset of COVID-19 restrictions (March 16, 2020–June 30, 2020) were compared with those admitted during the same period in 2019. We compared (1) rate of patients with GSW and (2) characteristics of patients with GSW, by period using Χ2 tests or Fisher’s exact tests, as appropriate.ResultsThere were 6996 trauma admissions across the study period; 3707 (53%) in 2019 and 3289 (47%) in 2020. From 2019 to 2020, there was a significant increase in GSW admissions (4% vs. 6%, p=0.001); 4 weeks specifically had significant increases (March 16–March 23: 4%, April 1–April 8: 5%, April 9–April 16: 6%, and May 11–May 18: 5%). Of the 334 GSWs, there were significant increases in patients with mental illness (5% vs. 11%, p=0.03), alcohol use disorder (2% vs. 10%, p=0.003), substance use disorder (11% vs. 25%, p=0.001), and a significant decrease in mortality (14% vs. 7%, p=0.03) in 2020. No other significant differences between time periods were identified.ConclusionOur data suggest that trauma centers admitted significantly more patients with GSW following the national guidelines, including an increase in those with mental illness and substance use-related disorders. This could be attributable to the stay-at-home orders.Level of evidenceLevel III, retrospective study.

Unequal Burden of Injury at Level I Trauma Centers: The Case for Efficiency in Resource Allocation for Optimal Trauma Care

2014 ◽  
Vol 219 (3) ◽  
pp. S104-S105
Author(s):  
Zain G. Hashmi ◽  
Syed Nabeel Zafar ◽  
Adil A. Shah ◽  
Eric B. Schneider ◽  
William R. Leeper ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Trauma Care ◽  
Trauma Centers ◽  
Level I

scholarly journals Models of care for traumatically injured patients at trauma centres in British Columbia: variability and sustainability

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 200-206 ◽  
Author(s):  
Benjamin Tuyp ◽  
Kasra Hassani ◽  
Lisa Constable ◽  
Joseph Haegert
Keyword(s):  
Trauma Care ◽  
Trauma System ◽  
Models Of Care ◽  
Short Stay ◽  
Trauma Centres ◽  
Trauma Unit ◽  
Trauma Service ◽  
Level Ii ◽  
Level I ◽  
Injured Patients

AbstractBackgroundSuccessful trauma systems employ a network of variably-resourced hospitals, staffed by experienced providers, to deliver optimal care for injured patients. The “model of care”—the manner by which inpatients are admitted and overseen, is an important determinant of patient outcomes.ObjectivesTo describe the models of inpatient trauma care at British Columbia’s (BC’s) ten adult trauma centres, their sustainability, and their compatibility with accreditation guidelines.MethodsQuestionnaires were distributed to the trauma medical directors at BC’s ten Level I-III adult trauma centres. Follow-up semi-structured interviews clarified responses.ResultsThree different models of inpatient trauma care exist within BC. The “admitting trauma service” was a multidisciplinary team providing exclusive care for injured patients. The “on-call consultant” assisted with Emergency Department (ED) resuscitation before transferring patients to a non-trauma admitting service. The single “short-stay trauma unit” employed on-call consultants who also oversaw a 48-hour short-stay ward.Both level I trauma centres utilized the admitting trauma service model (2/2). All Level II sites employed an on-call consultant model (3/3), deviating from Level II trauma centre accreditation standards. Level III sites employed all three models in similar proportions. None of the on-call consultant sites believed their current care model was sustainable. Inadequate compensation, insufficient resources, and difficulty recruiting physicians were cited barriers to sustainability and accreditation compliance.ConclusionsThree distinct models of care are distributed inconsistently across BC’s Level I-III trauma hospitals. Greater use of admitting trauma service and short-stay trauma unit models may improve the sustainability and accreditation compliance of our trauma system.

scholarly journals National estimates of the use and outcomes of extracorporeal membrane oxygenation after acute trauma

2019 ◽  
Vol 4 (1) ◽  
pp. e000209 ◽  
Author(s):  
Parker J Hu ◽  
Lauren Griswold ◽  
Lauren Raff ◽  
Rachel Rodriguez ◽  
Gerald McGwin Jr ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Statistical Significance ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Traumatic Injuries ◽  
Membrane Oxygenation ◽  
Diagnostic Codes ◽  
The Usa ◽  
Ninth Edition ◽  
National Estimates

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for patients with severe acute respiratory distress syndrome is gaining greater acceptance among trauma intensivists. The objective of this study was to review ECMO usage in trauma patients in the USA.MethodsThe National Inpatient Sample (NIS) from years 2002 to 2012 was queried for patients aged 15 and older treated with ECMO who had one or more acute traumatic injuries as defined by the International Diagnostic Codes, Ninth Edition (ICD-9). The primary outcomes of interest were incidence of ECMO and overall inpatient mortality.ResultsA total of 1347 patients were identified in the NIS database who had both ECMO performed and ICD-9 codes consistent with trauma. Patients were predominantly aged 15 to 29 years (31.4%) and were male (65.5%). The incidence of ECMO for patients after traumatic injuries has increased 66-fold during the 10-year period. In-hospital mortality was 48.0% overall, with a decreasing trend during the study period that approached statistical significance (p=0.06).DiscussionAlthough ECMO use in patients in the post-trauma setting remains controversial, there is an increasing trend to use ECMO nationwide, suggesting an increasing acceptance and/or increased availability at trauma centers. Given the decrease in mortality during the study period, ECMO as a salvage method in trauma patients remains a potentially viable option. Evaluation in a prospective manner may clarify risks and benefits.Level of evidenceLevel IV, epidemiological.

scholarly journals Knee surgery and its evidence base

2016 ◽  
Vol 98 (03) ◽  
pp. 170-176 ◽  
Author(s):  
A Sharma ◽  
K Hasan ◽  
A Carter ◽  
R Zaidi ◽  
S Cro ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Evidence Base ◽  
Knee Surgery ◽  
Level Of Evidence ◽  
Significant Drop ◽  
Levels Of Evidence ◽  
Published Evidence ◽  
Significant Downward Trend ◽  
Level I ◽  
High Level

Introduction Evidence driven orthopaedics is gaining prominence. It enables better management decisions and therefore better patient care. The aim of our study was to review a selection of the leading publications pertaining to knee surgery to assess changes in levels of evidence over a decade. Methods Articles from the years 2000 and 2010 in The Knee, the Journal of Arthroplasty, Knee Surgery, Sports Traumatology, Arthroscopy, the Journal of Bone and Joint Surgery (American Volume) and the Bone and Joint Journal were analysed and ranked according to guidelines from the Centre for Evidence-Based Medicine. The intervening years (2003, 2005 and 2007) were also analysed to further define the trend. Results The percentage of high level evidence (level I and II) studies increased albeit without reaching statistical significance. Following a significant downward trend, the latter part of the decade saw a major rise in levels of published evidence. The most frequent type of study was therapeutic. Conclusions Although the rise in levels of evidence across the decade was not statistically significant, there was a significant drop and then rise in these levels in the interim. It is therefore important that a further study is performed to assess longer-term trends. Recent developments have made clear that high quality evidence will be having an ever increasing influence on future orthopaedic practice. We suggest that journals implement compulsory declaration of a published study’s level of evidence and that authors consider their study designs carefully to enhance the quality of available evidence.

scholarly journals P058: Improving patient safety and streamlining care at a community hospital through spread and scale of a trauma care bundle: a quality improvement pilot project

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S98-S98
Author(s):  
E. Hahn ◽  
R. Andres ◽  
T. de Kok ◽  
A. Brown ◽  
J. Doyle
Keyword(s):  
Quality Improvement ◽  
Health Outcomes ◽  
Patient Care ◽  
Trauma Care ◽  
Care Bundle ◽  
Trauma Centers ◽  
Community Hospitals ◽  
Golden Hour ◽  
Community Trauma ◽  
The Right

Introduction: Non-trauma centers (NTC) and community hospitals commonly deliver medical care during the “golden hour” of trauma, which has significant implications on the health outcomes of patients. The Niagara Health System (NHS) and its 3 community NTC hospitals provide trauma care to over 100 patients annually during this critical period. NTCs lack standardized resources commonly found in trauma centers. Checklists and bundles have been effective in streamlining process to ensure health care providers provide the right care, at the right time and address critical points during patient care. A trauma care bundle was designed and implemented in the NHS as a means to improve trauma care and patient outcomes. Methods: A quality improvement (QI) approach was used to design, implement and evaluate a trauma care bundle at one of the NHS’s community hospitals. These interventions were adapted and modified for community trauma care purposes. We piloted the trauma care bundle using rapid cycle improvements, known as Plan-Do-Study-Act (PDSA) cycles. We assessed outcome and process measures through a chart audit of all trauma care patients in the NHS from July 2015-December 2015. A safety attitudes questionnaire (SAQ) was administered to health system staff who were involved in the pilot to assess balancing measures. Results: Improvements to the bundle and its implementation from 4 PDSA cycles resulted in increased utilization. This continuous monitoring of the bundle and ongoing, conscious efforts to improve the intervention were used to spread and scale across all 3 sites of the NHS. 30% of patients received the trauma care bundle during phase 1 of the pilot from July 1- October 31, 2015. We are presently analyzing preliminary data to understand how the trauma care bundle impacts health outcomes and process and will present a comparative analysis between patient groups. Conclusion: Trauma care bundles may foster safer and more efficient patient care in community hospitals where the golden hour of trauma often occurs. This community trauma care bundle shows promising results for streamlining the care process to ensure patients receive appropriate care during the golden hour. Spread and scale of this bundle across other community hospitals will likely yield similar improvements in patient care.

scholarly journals Processes for Trauma Care at Six Level I Trauma Centers During the COVID-19 Pandemic

2021 ◽  
Vol 43 (1) ◽  
pp. 3-12
Author(s):  
Laura Harwood ◽  
Stephanie Jarvis ◽  
Kristin Salottolo ◽  
Diane Redmond ◽  
Gina M. Berg ◽  
...  
Keyword(s):  
Trauma Care ◽  
Trauma Centers ◽  
Level I

scholarly journals Comparison of trauma outcomes between Japan and the USA using national trauma registries

2018 ◽  
Vol 3 (1) ◽  
pp. e000247 ◽  
Author(s):  
Shokei Matsumoto ◽  
Kyoungwon Jung ◽  
Alan Smith ◽  
Motoyasu Yamazaki ◽  
Mitsuhide Kitano ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Trauma Care ◽  
Injury Severity ◽  
Data Bank ◽  
Care Quality ◽  
Hospital Length Of Stay ◽  
Secondary Outcome ◽  
Level Of Evidence ◽  
National Trauma ◽  
The Usa

BackgroundThe National Trauma Data Bank (NTDB) has served as a global benchmark for trauma care quality and outcomes. Herein, we compared patient characteristics, trauma management, and outcomes between Japanese emergency and critical care centers and US level 1 trauma centers using the Japanese Trauma Data Bank (JTDB) and NTDB.MethodsA retrospective cohort matching (1:1) study was performed. Patients treated in 2013 with an Injury Severity Score ≥9 were included. The primary outcome measure was in-hospital mortality. The secondary outcome measures included the hospital length of stay and the rate of use of radiological diagnostic modalities.ResultsA total of 14 960 pairs with well-balanced characteristics were generated from 22 535 and 112 060 eligible patients in the JTDB and NTDB, respectively. Before matching, the in-hospital mortality was higher in the JTDB than in the NTDB (7.6% vs. 6.1%; OR, 1.28; 95% CI 1.21 to 1.35). However, after matching, the in-hospital mortality was lower in the JTDB cohort (4.2% vs. 5.8%; OR, 0.72; 95% CI 0.65 to 0.80). CT scans were used in >80% of JTDB patients, which was more than 1.5 times as often as the use in the NTDB cohort. In subgroup analyses, only patients who received a blood transfusion had a poorer survival outcome in the JTDB compared with the NTDB (OR, 1.32; 95% CI 1.07 to 1.64).DiscussionWe observed marked differences in trauma care between Japan and the USA. Although the quality of the recent Japanese trauma care appears to be approaching that of the USA, it may be further improved, such as by the establishment of transfusion protocols.Level of evidenceLevel IV.

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