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Maintaining patient throughput on an evolving trauma/emergency surgery service
Mary Kate FitzPatrick1, Patrick M Reilly, Andrea Laborde
1Division of Traumatology and Surgical Critical Care, Department of Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA. fitzpatk@uphs.upenn.edu
The Journal of Trauma
|March 15, 2006
Summary
The case-management team (CMT) effectively manages trauma and emergency general surgery (EGS) patients, maintaining improved hospital throughput and reduced denied days and readmissions. This demonstrates the CMT's integral role in optimizing trauma service efficiency.
Area of Science:
- Healthcare Management
- Surgical Services
- Trauma Care
Background:
- Case-management teams (CMTs) have historically improved hospital throughput and reduced denied days in trauma services.
- The integration of emergency general surgery (EGS) patients into the trauma service prompted a review of the CMT's capacity.
- This study assessed the continued effectiveness of the CMT with an expanded patient population.
Purpose of the Study:
- To evaluate the impact of integrating emergency general surgery (EGS) patients on the trauma service's case-management team (CMT).
- To determine if the CMT could maintain previous improvements in hospital throughput and reduce denied days and readmissions.
- To assess the overall efficiency of the trauma service with the addition of EGS patients.
Main Methods:
- An interdisciplinary case-management team (CMT) was implemented in 1999, with nurse practitioners added in 2003.
- Data from trauma registries, hospital utilization review, and finance offices were analyzed for periods before (1998-1999) and after (2003-2004) the addition of EGS patients.
- Statistical tests of proportion were used to compare outcomes between the study periods.
Main Results:
- The trauma service experienced a significant increase in total admissions (56%) by 2004 due to the influx of 561 EGS patients.
- Despite increased volume, the percentage of denied days decreased from 4.6% in 1998 to 0.5% in 2004 (p<0.01).
- The percentage of readmissions also significantly decreased from 4.0% in 1998 to 1.8% in 2004 (p<0.01).
Conclusions:
- The case-management team (CMT) effectively maintained and continued to improve hospital throughput for the trauma service, even after incorporating emergency general surgery (EGS) patients.
- Key performance indicators, including reduced denied days and readmissions, demonstrate the sustained positive impact of the CMT.
- The CMT is crucial for maintaining the efficiency of combined trauma and emergency general surgery services.