TRAUMA SERVICE COST - THE REAL STORY

Objective The objective was to define and characterize the costs assoc iated with trauma care at a level I trauma center. Once the costs were identified, attending physician-led teams were designed to reduce cos ts within each cost center. Summary Background Data The location and m agnitude of the costs on a trauma service remain largely unknown. Focu sed cost-containment strategies remain difficult to implement because the expected return on these interventions is unknown. Methods Cost ce nter data were reviewed for the 40 major DRGs admitted for the first a months of the fiscal years 1996 and 1997. Data were obtained from the hospital finance department using the Transition Systems Inc. account ing system. We focused on variable direct costs, those that vary with patient volume (e.g., staff nursing expense and medical/surgical suppl ies). To address issues of inflation, pay raises, and changing costs, a proxy value was created for 1996 and costs were held constant for th e 1997 calculation. The major services that constitute cost centers id entified in the system were nursing, surgical, pharmacy, laboratory, r adiology, and emergency services. Attendings were assigned to develop and oversee customized cost-reduction modalities specific to each cost center. The cost-reduction modalities used to achieve significant sav ings were as follows: nursing, case management approach focusing on ea rly discharge; surgical, meeting with operating room (OR) purchasing t o modify expensive behavior patterns; pharmacy, integrating clinical p harmacist with direct attending support; laboratory, enforcing protoco l for lab draws; radiology, increasing the use of emergency room ultra sound and accepting outside x-rays; and emergency services, 24-hour in -house attending staff to reduce emergency room time. The surgical and emergency services cost centers predominately generate costs by the l ength of time care is delivered in that area. Results For each period, data from 363 patients were compared. Mean length of stay decreased b etween the study periods from 8.72 to 7.06 days, while the average inj ury severity score was unchanged. Together, these cost centers constit uted 87.4% of the total cost of care delivered. Significant cost reduc tion was achieved in all six variable cost centers: nursing (24%), sur gical (5%), pharmacy (57%), laboratory (27), radiology (7%), and emerg ency (36). The mean cost per case was reduced by 25%. Conclusions Iden tification of the true cost centers and directed attending surgeon inv olvement are essential to the development and implementation of a succ essful cost-reduction process.