Hostname: page-component-77c89778f8-n9wrp Total loading time: 0 Render date: 2024-07-20T17:39:33.586Z Has data issue: false hasContentIssue false

Analysis of Hospital Ability to Provide Trauma Services: A Comparison between Teaching and Community Hospitals

Published online by Cambridge University Press:  28 June 2012

Keith W. Neely*
Affiliation:
Division of Emergency Medicine, Oregon Health Sciences University, Portland, Ore., USA
Robert L. Norton
Affiliation:
Division of Emergency Medicine, Oregon Health Sciences University, Portland, Ore., USA
Ed Bartkus
Affiliation:
Division of Emergency Medicine, Oregon Health Sciences University, Portland, Ore., USA
John A. Schiver
Affiliation:
Division of Emergency Medicine, Oregon Health Sciences University, Portland, Ore., USA
*
Division of Emergency Medicine, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97201-3098, USA

Abstract

Hypothesis:

Teaching hospitals (TH) can maintain the American College of Surgeons Committee on Trauma (ACSCOT) criteria for Level II trauma care more consistently than can community hospitals (CH).

Methods:

A retrospective analysis of 2,091 trauma system patients was done to determine if TH in an urban area are better able to meet the criteria for Level II trauma care than are CH. During the study period, a voluntary trauma plan existed among five hospitals; two TH and three CH. A hospital could accept patients that met trauma system entry criteria as long as, at that moment, it could provide the resources specified by ACSCOT. Hospitals were required to report their current resources accurately. A centralized communications center maintained a computerized, inter-hospital link which continuously monitored the availability of all participating hospitals. Trauma system protocols required paramedics to transport system patients to the closest available trauma hospital that had all the required resources available. Nine of the required ACSCOT Level II trauma center criteria were monitored for each institution emergency department (ED); trauma surgeon (TS); operating room (OR); angiogaphy (ANG); anesthesiologist (ANE); intensive care unit (ICU); on-call surgeon (OCS); neurosurgeon (NS); and CT scanner (CT) available at the time of each trauma system entry.

Results:

With the exception of OR, TH generally maintained the required staff and services more successfully than did CH. Further, less day to night variation in the available resources occurred at the TH. Specifically, ANE, ICU, TS, NS and CT were available more often both day and night, at TH than CH. However, OR was less available at TH than CH during both day and night (p<.01).

Conclusions:

In this community, TH provided a greater availability of trauma services than did CH. This study supports the designation of TH as trauma centers. A similar availability analysis can be performed in other communities to help guide trauma center designation.

Type
Administrator
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at the 6th Annual Meeting of the National Association of EMS Physicians at Houston, Texas, June 1990.

References

1. Cales, RH, Trunkey, DD: Preventable trauma deaths: A review of trauma care systems development. JAMA 1985;254:10591063.CrossRefGoogle ScholarPubMed
2. Cales, RH: Trauma mortality in Orange County: The effect of implemention of a regional trauma system. Ann Emerg Med 1984;13:l10.CrossRefGoogle ScholarPubMed
3. Lowe, DK, Gately, HL, Goss, JR et al. : Patterns of death, complication, and error in the management of motor vehicle accident victims: Implications for a regional trauma system. J Trauma 1984;23:503509.CrossRefGoogle Scholar
4. West, JG, Trunkey, DD, Lim, RC: Systems of trauma care: A study of two counties. Arch Surg 1979;114:455460.CrossRefGoogle ScholarPubMed
5. American College of Surgeons: Optimal Hospital Resource for Care of the Injured Patient. American College of Surgeons, Committee of Trauma, 1990.Google Scholar
6. Neely, KN, Moorhead, JC, Long, W: Computerized trauma communications system in interface, Jems 1988;13:7679.Google Scholar
7. Neely, KN, Bennison, A, Acker, A et al. : CHORAL (Computerized Hospital On Line Resource Allocation Link): A mechanism to monitor and establish policy for hospital ambulance divesions. Prehospital and Disaster Medicine 1991;6:447450.CrossRefGoogle Scholar
8. The OCS was defined as a TS but only when available within 15 minutes of time the patient reached the emergency department This was considered a back-up surgeon.Google Scholar
9. Norton, RL, Neely, KN, Bartkus, E et al. : Compliance with closest hospital transportation protocol. Prehospital and Disaster Medicine 1990:6:295. Abstract.Google Scholar
10. Maull, KI, Schwab, W, McHenry, SD et al. : Trauma center verification. J Trauma 1986;26:521525.CrossRefGoogle ScholarPubMed