Trauma center maturation - Quantification of process and outcome

Background and Objective The regional trauma system with the trauma center as its center is a model for health care networks. However, trauma center maturation has not been de fined in the literature. The authors' hypothesis was that maturation of the trauma center would affect quantitatively both process and patient outcome . Materials and Methods A total of 15,303 trauma patients were admitted from 1987 to 1995. Annual a dmissions increased from 813 to 2669. Resources were generated as patient v olume increased. Time to the operating room, length of stay, and complicati ons were determined. TRISS methodology was used to calculate z scores and w values to compare actual with predicted mortality rates. Results Time to the operating room for laparotomy decreased from 62 +/- 73 to 35 +/ - 47 minutes, from 32 +/- 32 to 20 +/- 17 minutes in hypotensive patients, and for craniotomy decreased from 88 +/- 54 to 67 +/- 49 minutes. The incid ence of infectious, airway, neurologic, orthopedic, respiratory, gastrointe stinal, and procedure-related complications declined significantly. Z score s and w values increased for penetrating and blunt injuries. Deaths for pat ients with ISS >15 declined significantly. Hospital length of stay decrease d for all ranges of injury severity. Conclusions As the trauma center matured, the process of delivering patient care became more efficient. The result was improved survival, fewer complications, and a shorter length of stay.