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Defining excess resource utilization and identifying associated factors for trauma victims
G E O'Keefe1, G J Jurkovich, R V Maier
1Department of Surgery, University of Texas, Southwestern Medical Center, Dallas 75235-9158, USA. gokeef@mednet.swmed.edu
The Journal of Trauma
|March 24, 1999
Summary
Prolonged hospital length of stay (LOS) after trauma is an adverse outcome. Estimating expected LOS and identifying outliers helps improve trauma care systems and centers.
Area of Science:
- Trauma Care Systems
- Health Services Research
Background:
- Trauma system evaluation traditionally focuses on process, structure, and outcomes.
- Hospital length of stay (LOS) is a key indicator of resource utilization and care efficiency.
- Identifying excessive LOS can reveal opportunities for trauma system improvement.
Purpose of the Study:
- To estimate expected hospital LOS for trauma patients.
- To determine the consequences of prolonged hospital LOS.
Main Methods:
- Retrospective review of trauma patients admitted between January 1, 1993, and December 31, 1994.
- Definition of excess LOS as observed LOS >= 100% of expected LOS.
- Comparison of injuries, complications, and audit filters between patients with and without excess LOS.
Main Results:
- 10.9% of patients (568/5,226) experienced excess LOS (>=100% over expected), with a 98.3% survival rate.
- Complications were predictive of excess LOS, while American College of Surgeons' audit filters were not.
- Excess LOS patients incurred median costs of $30,315, accounting for 30% of total cohort expenditures.
Conclusions:
- Prolonged hospital LOS is an adverse outcome in trauma care.
- Estimating expected LOS and evaluating outliers is crucial for assessing care quality in trauma systems.
- This method aids in identifying areas for improvement within established trauma centers.