IMPACT OF THE IN-HOUSE TRAUMA SURGEON ON INITIAL PATIENT-CARE, OUTCOME, AND COST

Background: The purpose of this study is to evaluate the effect of hav ing attending trauma surgeons with added qualifications in surgical cr itical care present for the initial resuscitation at a regional trauma center, Methods: This study is a retrospective review of patients adm itted between August of 1994 and December of 1995 from our trauma regi stry, The patients were categorized by the call preference of the admi tting physician as in-house (IH) or call-back from home (CB), day of a dmission (weekend vs, weekday), time of admission (AM vs, PM), and a v alue of the injury severity scale less than or equal to 15 or >15, Dem ographics, admission vital signs, Injury Severity Scale, Glasgow Coma Score, and elapsed time to diagnostic, therapeutic, and/or operative i nterventions were studied, The effect on intensive care unit length of stay, mortality, and hospital cost for resuscitation were also studie d, Results: The study population consisted of 1,043 patients, The IH a nd CB groups each included two attending surgeons, IH significantly re duced the average time to completion of diagnostic peritoneal lavage ( 22 vs, 34 minutes; p<0.05), therapeutic intervention (21 vs 38 minutes ; p<0.05), and transport to the operating room (206 vs, 312 minutes; p <0.05) during the AM compared with CB, There was no difference in thes e times for the PM admissions, There was no significant difference in intensive care unit length of stay, Among patients with severe head an d thoracoabdominal injury (Abbreviated Injury Score >4 and 3, respecti vely) there was no difference in mortality, Analysis of cost for emerg ency room resuscitation in severely injured patients (Injury Severity Score greater than or equal to 15), seen during weekdays, was signific antly less when evaluated by IH (IH = $5,097 vs, CB = $6,779; p<0.05), Conclusions: During the initial resuscitation of patients with severe ly injured during the weekdays, IH significantly reduced the cost, and elapsed time to diagnostic testing, therapeutic intervention, and to the operating room, respectively, IH reduced fatalities compared with CB.