EFFECT OF SURGICAL PANEL COMPOSITION ON PATIENT OUTCOME AT A LEVEL-I TRAUMA CENTER

Objective: To compare the effect of staffing with general surgeons vs trauma specialists on patient outcome at a trauma center. Design: The care of injured patients at a level I urban trauma center serving a po pulation of 2.5 million was the responsibility of 12 surgeons (10 gene ral surgeons and 2 trauma specialists) between January 1 and June 30, 1996 (group 1). Between July 1 and December 31, 1996 (group 2), trauma was the responsibility solely of 4 trauma specialists. An additional comparison was made with those patients in, group 1 who were admitted to the general surgeons (group 1A). The outcomes and quality of care f or these periods, as determined by the quality assurance screens, were retrospectively analyzed and compared. Setting: Urban, tertiary care, level I trauma center. Participants: Each trauma and burn patient adm itted during the study periods is included in this study. Upon the pat ient's discharge from the hospital, specially trained nurses completed a review of the patient's stay and entered it into the Trauma One dat abase (Lancet Technology Inc, Cambridge, Mass). There were 693 trauma patients in group 1 (472 in group 1A) and 734 patients in group 2. Mai n Outcome Measures: Mortality, length of stay, and 16 quality assuranc e screens were quantified and compared using chi(2) analyses and t tes ts. Results: The age and sex of the 2 groups were similar. The mortali ty rate was 6.2% (43/693) in group 1, 6.1% (29/472) in group 1A, and 6 .5% (48/734) in group 2 (P =.80 and P =.78, respectively). When strati fied by injury severity score (ISS), lengths of stay were statisticall y similar, except for patients with an ISS of 0 to 7. Patients with an ISS of 0 to 7 in groups 1 and 1A stayed a mean of 2.6 days, compared with 3.2 days for group 2 (P =.01 and P =.02, respectively). The resul ts of quality assurance screens (missed injury, wound infection, readm ission, and 13 others) were similar in the 2 groups. Conclusions: Tran sitions in staffing afforded the opportunity to examine patient outcom es by surgeon specialization and frequency of call. In our sample, 12 well-trained surgeons taking call less frequently managed a trauma ser vice as efficiently as a group of 4 trauma specialists, without any di fferences in morbidity and mortality.