Time and motion: A study of trauma surgeons' work at the bedside during the first 24 hours of blunt trauma care

Background: The current literature defines the costs of trauma care in term s of hospital costs and charges, We sought to define the qualitative and qu antitative labor costs of trauma care by measuring the various components o f bedside care provided by surgeons at a community hospital, Methods: We conducted a prospective time-and-motion study during the initia l 24 hours of blunt trauma patients' stay in the hospital at a Level II tra uma center. The services provided by two surgeons and one nurse practitione r were examined. All patients were resuscitated and seen initially by one o f the physicians. Ten service elements (SEs) were defined, and total time ( TT) spent was the sum of time spent on all service elements for that patien t. We defined labor cost as TT, Data on Injury Severity Score (ISS), alcoho l intoxication, length of stay, operative procedures, and injury mechanism were also collected. Data are in minutes as means +/- SEM, Analysis of line ar correlation was by Pearson correlation coefficient, and intergroup compa rison of means was by two-tailed t test. Results: Fifty-eight patients were studied. Mean ISS and length of stay wer e 11.8 +/- 3 and 4.6 +/- 3 days, respectively. A mean of seven SEs were pro vided per patient, and the number of SEs provided correlated directly with ISS (r = 0.75, p < 0.01), The mean TT spent was 171 +/- 9 minutes, and it c orrelated directly with ISS (r = 0.64, p < 0.01), For patients undergoing o perative procedures by the trauma surgeon, the procedures consumed the grea test portion of TT: 73 +/- 6 minutes (24%), For patients not undergoing ope rative procedures, resuscitation and time spent in the radiology department consumed the majority of TT: 30 minutes for each SE (40% of TT), Serum eth anol was greater than 0.10 in 33 of 58 patients (57%), and these patients r equired significantly more TT (135 vs. 193 minutes; p < 0.05) than nonintox icated patients. Conclusion: A significant labor cost (TT) was required for the care of blun t trauma patients, and the majority of that cost was not spent in the opera ting room but involved the performance of cognitive services. Significant c orrelation existed between ISS and labor cost. The presence of ethanol into xication significantly increased this commitment. These data might be of us e in creating provider reimbursement schemes for trauma care. This methodol ogy may have applications in the design of hospital systems for trauma care .