NEUROSURGICAL TRAUMA CALL - USE OF A MATHEMATICAL SIMULATION PROGRAM TO DEFINE MANPOWER NEEDS

Resource criteria for trauma centers (TC) mandate a first plus backup neurosurgeon (NS) coverage, an unnecessary expense for TC treating few neurosurgery patients, This report uses a mathematical modeling syste m to define optimal NS trauma coverage, Random data from 749 patients treated with emergency neurosurgery operations (OR) within 24 hours of admission at 97 TC were used to create a 1-year profile of admission by month, day, and hour, operation times, and operation duration, Thes e data were entered into a simulation program to define the frequency that a patient needing a NS consult would wait beyond 30 minutes becau se the NS was in the operating room at a trauma center with one, two, or three neuro-surgeons on-call, One thousand iterations were done for each sample size of 25 to 300 patients in 25-patient increments, The probability that a patient could not be seen promptly by one NS in a t rauma center operating on 25, 50, 75, or 100 patients per year is 0.23 , 0.9, 1.6, and 3.66 patients per year, Fewer than one patient (0.75) per year will wait more than 30 min in a trauma center doing 225 emerg ency ORs when two neurosurgeons are on-call, One patient in 10 years m ould wait more than 30 min in a trauma center doing 300 ORs with a thi rd NS on-call, Mathematical modeling of patient data helps define opti mal hospital resources, Mandatory NS backup for TC performing fewer th an 25 neurosurgery procedures is unneeded.