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In-house versus on-call attending trauma surgeons at comparable level I trauma centers: a prospective study
G B Demarest1, G Scannell, K Sanchez
1Department of Surgery, University of New Mexico School of Medicine, Albuquerque. gdemarest@salud.unm.edu
The Journal of Trauma
|April 27, 1999
Summary
Trauma surgeons on-call from home (OC) can provide care equal to in-house trauma surgeons (IH) if they are within a 15-minute response time. This study found no significant differences in clinical outcomes or mortality rates between the two models.
Area of Science:
- Trauma Surgery
- Surgical Outcomes
- Healthcare Management
Background:
- Comparing patient outcomes based on the presence of in-house versus on-call attending trauma surgeons.
- Focus on comparable Level I trauma centers to ensure consistent quality of care.
Purpose of the Study:
- To prospectively compare patient outcomes between in-house (IH) and on-call (OC) attending trauma surgeons.
- Evaluate the impact of surgeon availability on clinical care and mortality rates.
Main Methods:
- Prospective 6-month study at two Level I trauma centers: one with 24-hour in-house trauma surgeons (IH), one with on-call surgeons (OC) within 15 minutes.
- Included trauma patients with Injury Severity Score >= 16.
- Compared demographics, clinical presentation, times to care, and mortality rates.
Main Results:
- Institutions differed in environment, size, and patient volume.
- IH patients were older with higher Injury Severity Scores and lower Glasgow Coma Scale scores.
- On-call trauma surgeons responded equally or more rapidly than in-house surgeons, with no significant differences in care times or outcomes.
Conclusions:
- On-call trauma surgeons within a 15-minute response time can achieve similar clinical care and mortality rates as in-house surgeons.
- Effective trauma alert systems enable equal provision of care and outcomes for acutely injured patients regardless of surgeon staffing model.