IS 24-HOUR OPERATING-ROOM STAFF ABSOLUTELY NECESSARY FOR LEVEL II TRAUMA CENTER DESIGNATION

Recent papers from established trauma centers reported average elapsed times from emergency department (ED) admission to the operating room (OR) of greater than 100 minutes for patients judged to be in immediat e need of surgery. This study was undertaken to determine whether pati ents treated at an institution desiring level II trauma center designa tion in a geographic area with a low incidence of penetrating trauma s uffered any adverse effects because of lack of a 24-hour in-house OR s taff. Trauma registry data at The Stamford Hospital, a suburban commun ity teaching hospital without OR nursing staff in-house at night, were reviewed and compared with data from three affiliated level I trauma centers and with established national standards using TRISS methodolog y. Of 659 major trauma patients, 86 (44 blunt, 42 penetrating) underwe nt surgery within 12 hours of admission. Patients' injuries were simil ar in severity to those seen at the affiliated trauma centers and to t he Major Trauma Outcome Study population. Mortality rates were also si milar. No statistically significant differences were seen in elapsed t imes from ED arrival to OR arrival even in the subgroup of patients wi th systolic blood pressure values of less-than-or-equal-to 90 mm Hg. N o unexpected adverse outcomes could be ascribed to the lack of 24-hour OR staffing in this setting. The estimated cost of providing addition al OR staffing is $145,000 per year. Since times to the OR and outcome s were similar to those at level I centers, this expense may not be wa rranted.