Date of Award

January 2011

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Kimberly A. Davis

Second Advisor

John Geibel

Subject Area(s)

Surgery, Management, Health care management

Abstract

Introduction: The purpose of this study was to determine whether trauma team oversight of patient management would positively affect efficiency of care as defined by improved patient throughput, with augmentation of both clinical and economic outcomes.

Methods: All patients activating the trauma team at a Level I trauma center over two time periods (last six months of 2005 and 2006) were reviewed. Trauma team activation criteria remained constant across the two time periods. During period one, patients were admitted to multiple services depending on injury pattern, while in period two, most patients were admitted to the trauma service for trauma team oversight of their management. In period two, improved documentation and appropriate coding was encouraged. Data are reported as mean ± SD, and median.

Results: Patient demographics and payer mix were similar over the two time periods. The number of full-time trauma surgeons remained constant. Trauma activations increased from 407 to 651 (p<0.05). The percentage of patients admitted to the trauma service also increased (68% vs. 86%, p<0.001). The mean injury severity score decreased (15 ± 15 vs. 12 ± 11, p<0.0001) although 3

the median ISS score remained stable at 9. Linear regression analysis identified ISS and admission during the later time period as significant predictors of decreased length of stay. Hospital length of stay also decreased significantly. Changes in billings and coding practices resulted in statistically significant increases in trauma surgeon work relative value units (182% increase), charges (360% increase) and collections (280% increase). The increased system efficiency resulted in significant decreases in the actual hospital costs per patient and led to the generation of an overall net positive hospital contribution margin per patient.

Conclusions: Implementation of trauma team oversight of patient care resulted in increased efficiency of care delivery, with shorter hospital lengths of stay despite increased patient volume. This paradigm change, coupled with improved documentation and coding, resulted in improved reimbursement for the physician, and lower cost per discharge for the hospital.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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