Resource commitment to improve outcomes and increase value at a level I trauma center.

Area of Science:

• Trauma Care
• Healthcare Management
• Nursing Practice

Background:

• Optimal trauma patient care necessitates efficient resource allocation and cost-effective strategies.
• Trauma centers must balance resource commitment with quality of care.
• Evaluating the impact of structural and staffing changes is crucial for trauma system improvement.

Purpose of the Study:

• To assess the effect of establishing a dedicated trauma care unit (TCU) and integrating advanced practice nurses on care quality and cost.
• To determine the impact of these changes on the overall value delivered by an adult Level I trauma center.
• To quantify improvements in patient outcomes and cost-efficiency.

Main Methods:

• A retrospective analysis of four 1-year intervals at an adult Level I trauma center.
• Data collected included patient demographics, injury severity, length of stay, complications, outcomes, and direct costs.
• Interventions evaluated: trauma team with surgeons/residents, addition of nurse practitioners, creation of a dedicated TCU, and increased advanced practice nurse coverage.

Main Results:

• Despite increased patient volume and severity (higher Injury Severity Score, more elderly patients), risk-adjusted mortality remained unchanged.
• A significant decrease was observed in patient complications (20.8% to 14.9%) and intensive care unit length of stay (39.5 to 23.4 hours).
• Median cost of care decreased ($4,306 to $3,698), and value improved, evidenced by reduced median costs for survivors and survivors without complications.

Conclusions:

• The integration of a dedicated trauma care unit and advanced practice nurses demonstrably enhanced the quality of trauma patient care.
• These changes led to a significant reduction in healthcare costs associated with trauma patient management.
• The study concludes that these improvements resulted in increased overall value at the adult Level I trauma center.