Enhanced trauma program commitment at a level I trauma center: Effect on the process and outcome of care

Edward E. Cornwell, David C. Chang, Judith Phillips, Kurtis A. Campbell, George C. Velmahos, Richard Mullins, David Wisner, Gill Cryer, James J. Peck, John C. Mayberry, John T. Owings

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

Hypothesis: With advances in surgical care, the occurrences of major adverse outcomes have become a rare event. The effect of a surgical service can be more comprehensively evaluated by following the Donabedian model, looking at the triad of structure, process, and outcome. It is hypothesized that the implementation of a focused program commitment at a trauma center is associated with improvements in process of care and patient outcomes. Design: Evaluation of prospectively collected information in a trauma registry for the 3-year periods immediately before (1995-1997) and after (1999-2001) the implementation (in 1998) of the full-time trauma service. Setting: Level I university-affiliated trauma center. Patients: Patients meeting criteria for major trauma. Intervention: The implementation of a full-time trauma service, featuring 24-hour in-house attending coverage, dedicated trauma admitting unit, regular trauma core curriculum, regular multidisciplinary quality assurance meetings, and state designation for level I status. Main Outcome Measures: Process of care measures, including time in the emergency department (ED) and trauma "bypass" hours (ie, time spent in the trauma resuscitation area). Outcome measures, including lengths of stay, overall mortality and mortality, excluding ED deaths. Results: The total number of patients with major trauma increased from 2240 (1995-1997) to 2513 (1999-2001). The average time in the ED for patients going to the operating room, intensive care unit, and observation wards all decreased significantly (84 vs 52 minutes, 197 vs 118 minutes, and 300 vs 140 minutes, respectively; all with P

Original languageEnglish (US)
Pages (from-to)838-843
Number of pages6
JournalArchives of Surgery
Volume138
Issue number8
DOIs
StatePublished - Aug 1 2003
Externally publishedYes

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Trauma Centers
Wounds and Injuries
Outcome and Process Assessment (Health Care)
Hospital Emergency Service
Outcome Assessment (Health Care)
Process Assessment (Health Care)
Mortality
Operating Rooms
Resuscitation
Curriculum
Intensive Care Units
Registries
Length of Stay
Patient Care
Observation

ASJC Scopus subject areas

  • Surgery

Cite this

Cornwell, E. E., Chang, D. C., Phillips, J., Campbell, K. A., Velmahos, G. C., Mullins, R., ... Owings, J. T. (2003). Enhanced trauma program commitment at a level I trauma center: Effect on the process and outcome of care. Archives of Surgery, 138(8), 838-843. https://doi.org/10.1001/archsurg.138.8.838

Enhanced trauma program commitment at a level I trauma center : Effect on the process and outcome of care. / Cornwell, Edward E.; Chang, David C.; Phillips, Judith; Campbell, Kurtis A.; Velmahos, George C.; Mullins, Richard; Wisner, David; Cryer, Gill; Peck, James J.; Mayberry, John C.; Owings, John T.

In: Archives of Surgery, Vol. 138, No. 8, 01.08.2003, p. 838-843.

Research output: Contribution to journalArticle

Cornwell, EE, Chang, DC, Phillips, J, Campbell, KA, Velmahos, GC, Mullins, R, Wisner, D, Cryer, G, Peck, JJ, Mayberry, JC & Owings, JT 2003, 'Enhanced trauma program commitment at a level I trauma center: Effect on the process and outcome of care', Archives of Surgery, vol. 138, no. 8, pp. 838-843. https://doi.org/10.1001/archsurg.138.8.838
Cornwell, Edward E. ; Chang, David C. ; Phillips, Judith ; Campbell, Kurtis A. ; Velmahos, George C. ; Mullins, Richard ; Wisner, David ; Cryer, Gill ; Peck, James J. ; Mayberry, John C. ; Owings, John T. / Enhanced trauma program commitment at a level I trauma center : Effect on the process and outcome of care. In: Archives of Surgery. 2003 ; Vol. 138, No. 8. pp. 838-843.
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