What are the Costs of Trauma Center Readiness? Defining and Standardizing Readiness Costs for Trauma Centers Statewide

2017 ◽  
Vol 83 (9) ◽  
pp. 979-985 ◽  
Author(s):  
◽  
Dennis W. Ashley ◽  
Robert F. Mullins ◽  
Christopher J. Dente ◽  
Laura Garlow ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injured Patient ◽  
Trauma Centers ◽  
Conference Calls ◽  
Optimal Care ◽  
Survey Tool ◽  
Level Ii ◽  
Level I ◽  
One Year ◽  
Patient Guidelines

Trauma center readiness costs are incurred to maintain essential infrastructure and capacity to provide emergent services on a 24/7 basis. These costs are not captured by traditional hospital cost accounting, and no national consensus exists on appropriate definitions for each cost. Therefore, in 2010, stakeholders from all Level I and II trauma centers developed a survey tool standardizing and defining trauma center readiness costs. The survey tool underwent minor revisions to provide further clarity, and the survey was repeated in 2013. The purpose of this study was to provide a follow-up analysis of readiness costs for Georgia's Level I and Level II trauma centers. Using the American College of Surgeons Resources for Optimal Care of the Injured Patient guidelines, four readiness cost categories were identified: Administrative, Clinical Medical Staff, Operating Room, and Education/Outreach. Through conference calls, webinars and face-to-face meetings with financial officers, trauma medical directors, and program managers from all trauma centers, standardized definitions for reporting readiness costs within each category were developed. This resulted in a survey tool for centers to report their individual readiness costs for one year. The total readiness cost for all Level I trauma centers was $34,105,318 (avg $6,821,064) and all Level II trauma centers was $20,998,019 (avg $2,333,113). Methodology to standardize and define readiness costs for all trauma centers within the state was developed. Average costs for Level I and Level II trauma centers were identified. This model may be used to help other states define and standardize their trauma readiness costs.

Impact of adding Level II and III trauma centers on volume and disease severity at a nearby Level I trauma center

2014 ◽  
Vol 77 (5) ◽  
pp. 764-768 ◽  
Author(s):  
Brendan G. Carr ◽  
Juliet Geiger ◽  
Nathan McWilliams ◽  
Patrick M. Reilly ◽  
Douglas J. Wiebe
Keyword(s):  
Disease Severity ◽  
Trauma Center ◽  
Trauma Centers ◽  
Level Ii ◽  
Level I

Impact of Trauma Center Designation on Outcomes: Is There a Difference Between Level I and Level II Trauma Centers?

2012 ◽  
Vol 215 (3) ◽  
pp. 372-378 ◽  
Author(s):  
Laurent G. Glance ◽  
Turner M. Osler ◽  
Dana B. Mukamel ◽  
Andrew W. Dick
Keyword(s):  
Trauma Center ◽  
Trauma Centers ◽  
Level Ii ◽  
Level I

scholarly journals Primary admission and secondary transfer of trauma patients to Dutch level I and level II trauma centers: predictors and outcomes

2021 ◽  
Author(s):  
Claire R. L. van den Driessche ◽  
Charlie A. Sewalt ◽  
Jan C. van Ditshuizen ◽  
Lisa Stocker ◽  
Michiel H. J. Verhofstad ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Trauma Center ◽  
Regression Models ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Logistic Regression Models ◽  
Level Ii ◽  
Secondary Transfer ◽  
Level I

Abstract Purpose The importance and impact of determining which trauma patients need to be transferred between hospitals, especially considering prehospital triage systems, is evident. The objective of this study was to investigate the association between mortality and primary admission and secondary transfer of patients to level I and II trauma centers, and to identify predictors of primary and secondary admission to a designated level I trauma center. Methods Data from the Dutch Trauma Registry South West (DTR SW) was obtained. Patients ≥ 18 years who were admitted to a level I or level II trauma center were included. Patients with isolated burn injuries were excluded. In-hospital mortality was compared between patients that were primarily admitted to a level I trauma center, patients that were transferred to a level I trauma center, and patients that were primarily admitted to level II trauma centers. Logistic regression models were used to adjust for potential confounders. A subgroup analysis was done including major trauma (MT) patients (ISS > 15). Predictors determining whether patients were primarily admitted to level I or level II trauma centers or transferred to a level I trauma center were identified using logistic regression models. Results A total of 17,035 patients were included. Patients admitted primarily to a level I center, did not differ significantly in mortality from patients admitted primarily to level II trauma centers (Odds Ratio (OR): 0.73; 95% confidence interval (CI) 0.51–1.06) and patients transferred to level I centers (OR: 0.99; 95%CI 0.57–1.71). Subgroup analyses confirmed these findings for MT patients. Adjusted logistic regression analyses showed that age (OR: 0.96; 95%CI 0.94–0.97), GCS (OR: 0.81; 95%CI 0.77–0.86), AIS head (OR: 2.30; 95%CI 2.07–2.55), AIS neck (OR: 1.74; 95%CI 1.27–2.45) and AIS spine (OR: 3.22; 95%CI 2.87–3.61) are associated with increased odds of transfers to a level I trauma center. Conclusions This retrospective study showed no differences in in-hospital mortality between general trauma patients admitted primarily and secondarily to level I trauma centers. The most prominent predictors regarding transfer of trauma patients were age and neurotrauma. These findings could have practical implications regarding the triage protocols currently used.

Pediatric Trauma System Evaluation before and after Level II Verification

2019 ◽  
Vol 85 (11) ◽  
pp. 1281-1287
Author(s):  
Michael D. Dixon ◽  
Scott Engum
Keyword(s):  
Native American ◽  
Trauma Center ◽  
Injury Severity ◽  
Life Support ◽  
Pediatric Trauma ◽  
Trauma System ◽  
Trauma Centers ◽  
Level Ii ◽  
Level I ◽  
Pediatric Trauma Center

ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study ( P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group ( P = 0.0002); motorized recreational vehicle ( P = 0.028), violent ( P = 0.009), and other ( P = 0.0374) mechanism of injury categories; ambulance ( P = 0.0124), fixed wing ( P = 0.0028), and personal-owned vehicle ( P = 0.0112) modes of transportation. Decreased public injuries ( P = 0.0071) and advanced life support ambulance transportation ( P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.

Successful Incorporation of Performance Based Payments for Trauma Center Readiness Costs into the Georgia Trauma System

2017 ◽  
Vol 83 (9) ◽  
pp. 966-971
Author(s):  
◽  
Dennis W. Ashley ◽  
Jeffrey M. Nicholas ◽  
Christopher J. Dente ◽  
Tracy J. Johns ◽  
...  
Keyword(s):  
Trauma Center ◽  
Performance Metrics ◽  
Response Times ◽  
Trauma System ◽  
Performance Criteria ◽  
Trauma Centers ◽  
Conference Calls ◽  
Improvement Program ◽  
Level I ◽  
The Impact

As quality and outcomes have moved to the fore front of medicine in this era of healthcare reform, a state trauma system Performance Based Payments (PBP) program has been incorporated into trauma center readiness funding. The purpose of this study was to evaluate the impact of a PBP on trauma center revenue. From 2010 to 2016, a percentage of readiness costs funding to trauma centers was placed in a PBP and withheld until the PBP criteria were completed. To introduce the concept, only three performance criteria and 10 per cent of readiness costs funding were tied to PBP in 2010. The PBP has evolved over the last several years to now include specific criteria by level of designation with an increase to 50 per cent of readiness costs funding being tied to PBP criteria. Final PBP distribution to trauma centers was based on the number of performance criteria completed. During 2016, the PBP criteria for Level I and II trauma centers included participation in official state meetings/conference calls, required attendance to American College of Surgeons state chapter meetings, Trauma Quality Improvement Program, registry reports, and surgeon participation in Peer Review Committee and trauma alert response times. Over the seven-year study period, $36,261,469 was available for readiness funds with $11,534,512 eligible for the PBP. Only $636,383 (6%) was withheld from trauma centers. A performance-based program was successfully incorporated into trauma center readiness funding, supporting state performance measures without adversely affecting the trauma center revenue. Future PBP criteria may be aligned to designation standards and clinical quality performance metrics.

Should All Severely Injured Pediatric Patients be Treated at Pediatric Level I Trauma Centers? A National Trauma Data Bank Study

2015 ◽  
Vol 81 (10) ◽  
pp. 927-931
Author(s):  
Shin Miyata ◽  
Tobias Haltmeier ◽  
Kenji Inaba ◽  
Kazuhide Matsushima ◽  
Catherine Goodhue ◽  
...  
Keyword(s):  
Trauma Center ◽  
Pediatric Patients ◽  
Injury Severity ◽  
Pediatric Trauma ◽  
Data Bank ◽  
Trauma Centers ◽  
National Trauma ◽  
Level Ii ◽  
National Trauma Data Bank ◽  
Level I

The American College of Surgeons Committee on Trauma stratification system for trauma centers presumes that increasing levels of resources will improve patient outcomes. Although some supportive data exist in adult trauma, there is a paucity of evidence demonstrating improved survival in pediatric trauma when patients are treated primarily at Level I versus Level II pediatric trauma centers. We hypothesized that there is no difference in the mortality of comparably injured pediatric patients treated at these two types of facilities. The study population consists of all severely injured pediatric patients (18 years old or younger, injury severity score > 15) registered in the National Trauma Data Bank, treated in designated pediatric trauma centers. A total of 13,803 patients were included in the analysis and were separated into two groups: Pediatric Level I trauma center (n = 9690) and Pediatric Level II trauma center (n = 4113). Although analysis of the clinical characteristics of the unmatched groups showed significant differences including mortality rate (11.7% vs 15.4%, P < 0.001), case matching technique, comparing 2956 pairs, successfully eliminated demographic differences and, when adjusted for injury severity, showed no difference in mortality between center types (10.0% vs 10.1%, P = 0.966, odds ratio of mortality = 0.996 and 95% confidence interval = 0.841–1.180). Subgroup analyses including Glasgow Coma Scale < 9, need for immediate procedures, and ICD-9 (International Classification of Diseases) code groupings indicative of serious injury also failed to demonstrate statistically significant differences in mortality between trauma center types.

Association of Operative Repair Type and Trauma Center Designation With Outcomes in Ruptured Abdominal Aortic Aneurysm Repair

2020 ◽  
Vol 54 (4) ◽  
pp. 325-332 ◽  
Author(s):  
Lyndsey E. Wessels ◽  
Richard Y. Calvo ◽  
Michael J. Sise ◽  
Jason M. Bowie ◽  
William J. Butler ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Endovascular Repair ◽  
Trauma Center ◽  
Lower Risk ◽  
Open Repair ◽  
Teaching Hospitals ◽  
Trauma Centers ◽  
Level Ii ◽  
Abdominal Aortic ◽  
Level I

Objective: Open repair of ruptured abdominal aortic aneurysm (rAAA) has shown improved outcomes at trauma centers. Whether the benefit of trauma center designation extends to endovascular repair of rAAA is unknown. Methods: Retrospective cohort study using the California Office of Statewide Health Planning and Development 2007 to 2014 discharge database to identify patients with rAAA. Data included demographic and admission factors, discharge disposition, International Classification of Diseases, Ninth Revision, Clinical Modification codes, and hospital characteristics. Hospitals were categorized by trauma center designation and teaching hospital status. The effect of repair type and trauma center designation (level I, level II, or other—other trauma centers and nondesignated hospitals) was evaluated to determine rates and risks of 9 postoperative complications, in-hospital mortality, and 30-day postdischarge mortality. Results: Of 1941 rAAA repair patients, 61.2% had open and 37.8% had endovascular; 1.0% had both. Endovascular repair increased over the study interval. Hospitals were 12.0% level I, 25.0% level II, and 63.0% other. A total of 48.7% of hospitals were teaching hospitals (level I, 100%; level II, 42.2%; and other, 41.8%). Endovascular repair was significantly more common at teaching hospitals (41.5% vs 34.3%, P < .001) and was the primary repair method at level I trauma centers ( P < .001). Compared with open repair, endovascular repair was protective for most complications and in-hospital mortality. The risk for in-hospital mortality was highest among endovascular patients at level II trauma centers (hazard ratio 1.67, 95% confidence interval [CI]: 0.95-2.92) and other hospitals (hazard ratio 1.66, 95% CI: 1.01-2.72). Conclusions: Endovascular repair overall was associated with a lower risk of adverse outcomes. Endovascular repair at level I trauma centers had a lower risk of in-hospital mortality which may be a result of their teaching hospital status, organizational structure, and other factors. The weight of the contributions of such factors warrants further study.

The Effect of Trauma Center Designation on Organ Donor Outcomes in Southern California

2012 ◽  
Vol 78 (5) ◽  
pp. 535-539
Author(s):  
Ali Salim ◽  
Cherisse Berry ◽  
Eric J. Ley ◽  
Danielle Schulman ◽  
Marko Bukur ◽  
...  
Keyword(s):  
Trauma Center ◽  
Southern California ◽  
Organ Procurement ◽  
Organ Donor ◽  
Organ Shortage ◽  
Trauma Centers ◽  
Level Ii ◽  
Improved Outcomes ◽  
Versus Level ◽  
Level I

We sought to investigate the effect of trauma center designation on organ donor outcomes during a 5-year period. A retrospective study of the southern California regional Organ Procurement Organization database comparing trauma centers (n = 25) versus nontrauma centers (n = 171) and Level I (n = 7) versus Level II (n = 18) trauma centers between 2004 and 2008 was performed. A total of 16,830 referrals were evaluated and 44 per cent were from trauma centers. When compared with nontrauma centers (n = 171), trauma centers (n = 25) had a higher percentage of medically suitable eligible deaths (29 vs 16%, P < 0.001), total eligible deaths (22 vs 12%, P < 0.001), and eligible donors (14 vs 7%, P < 0.001). Trauma Centers had a significantly higher number of organs procured per donor (4.0 ± 1.6 vs 3.5 ± 1.6, P < 0.001), organs transplanted per donor (OTPD) (3.6 ± 1.8 vs 2.8 ± 1.8, P < 0.001), and higher organ yield (per cent 4 or greater OTPD [48 vs 31%, P < 0.001]). No significant differences were found between Level I and Level II trauma centers. Trauma centers demonstrate significantly better organ donor outcomes compared with nontrauma centers. Factors responsible for improved outcomes at trauma centers should be evaluated, reproduced, and disseminated to nontrauma centers to alleviate the growing organ shortage crisis.

Decreased Intracranial Pressure Monitor Use at Level II Trauma Centers is Associated with Increased Mortality

2012 ◽  
Vol 78 (10) ◽  
pp. 1166-1171 ◽  
Author(s):  
Galinos Barmparas ◽  
Matthew Singer ◽  
Eric Ley ◽  
Rex Chung ◽  
Darren Malinoski ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Trauma Center ◽  
Injury Severity ◽  
Regression Modeling ◽  
Trauma Centers ◽  
Icp Monitoring ◽  
Pressure Monitor ◽  
Brain Trauma Foundation ◽  
Level Ii ◽  
Level I

Previous investigations suggest outcome differences at Level I and Level II trauma centers. We examined use of intracranial pressure (ICP) monitors at Level I and Level II trauma centers after traumatic brain injury (TBI) and its effect on mortality. The 2007 to 2008 National Trauma Databank was reviewed for patients with an indication for ICP monitoring based on Brain Trauma Foundation (BTF) guidelines. Demographic and clinical outcomes at Level I and Level II centers were compared by regression modeling. Overall, 15,921 patients met inclusion criteria; 11,017 were admitted to a Level I and 4,904 to a Level II trauma center. Patients with TBI admitted to a Level II trauma center had a lower rate of Injury Severity Score greater than 16 (80 vs 82%, P < 0.01) and lower frequency of head Abbreviated Injury Score greater than 3 (80 vs 82%, P < 0.01). After regression modeling, patients with TBI admitted to a Level II trauma center were 31 per cent less likely to receive an ICP monitor (adjusted odds ratio [AOR], 0.69; P < 0.01) and had a significantly higher mortality (AOR, 1.12; P < 0.01). Admission to a Level II trauma center after severe TBI is associated with a decreased use of ICP monitoring in patients who meet BTF criteria as well as an increased mortality. These differences should be validated prospectively to narrow these discrepancies in care and outcomes between Level I and Level II centers.

scholarly journals Consensus-based Standards and Indicators to strengthen trauma center injury and violence prevention programs

2021 ◽  
Vol 6 (1) ◽  
pp. e000762
Author(s):  
Christy Adams ◽  
Deborah A Kuhls ◽  
Shelli Stephens-Stidham ◽  
Julie Alonso ◽  
Stewart Williams ◽  
...  
Keyword(s):  
Public Health ◽  
Violence Prevention ◽  
Injury Prevention ◽  
Trauma Center ◽  
Injured Patient ◽  
Prevention Programs ◽  
Public Health Approach ◽  
Trauma Centers ◽  
Optimal Care ◽  
Violence Prevention Programs

For decades, the American College of Surgeons Committee on Trauma (ACSCOT) has published Resources for Optimal Care of the Injured Patient, which outlines specific criteria necessary to be verified by the college as a trauma center, including having an organized and effective approach to prevention of trauma. However, the document provides little public health-specific guidance to assist trauma centers with developing these approaches. An advisory panel was convened in 2017 with representatives from national trauma and public health organizations with the purpose of identifying strategies to support trauma centers in the development of a public health approach to injury and violence prevention and to better integrate these efforts with those of local and state public health departments. This panel developed the Standards and Indicators for Model Level I and II Trauma Center Injury and Violence Prevention Programs. The document outlines five, consensus-based core components of a model injury and violence prevention program: (1) leadership, (2) resources, (3) data, (4) effective interventions, and (5) partnerships. We think this document provides the missing public health guidance and is an essential resource to trauma centers for effectively addressing injury and violence in our communities. We recommend the Standards and Indicators be referenced in the injury prevention chapter of the upcoming revision of ACSCOT’s Resources for Optimal Care of the Injured Patient as guidance for the development, implementation and evaluation of injury prevention programs and be used as a framework for program presentation during ACSCOT verification visits.

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