A model for an integrated emergency medicine/trauma service

Area of Science:

• Trauma Care
• Emergency Medicine
• Surgical Services
• Healthcare Systems Research

Background:

• Integrated multidisciplinary trauma services aim to optimize patient care.
• The role of different housestaff specialties in leading trauma resuscitation is an area of ongoing evaluation.
• Comparing outcomes based on team leadership is crucial for service improvement.

Purpose of the Study:

• To describe a model for an integrated multidisciplinary trauma service.
• To compare survival outcomes between patients resuscitated by emergency medicine (EM) versus surgical housestaff leading the trauma service.
• To assess the efficacy of different leadership models within trauma care.

Main Methods:

• A prospective observational study conducted at Hartford Hospital from July to December 1995.
• Inclusion criteria focused on severely injured patients (ICD-9-CM 800-959.9) meeting specific severity or disposition markers.
• TRISS (Trauma and Injury Severity Score) analysis was used to compare outcomes against national norms, comparing EM resident-led (group 1) and surgical resident-led (group 2) cohorts.

Main Results:

• A total of 609 patients were analyzed, with 141 (30%) resuscitated under EM resident leadership.
• No significant differences were observed in matched variables between the EM and surgical housestaff groups.
• Both groups demonstrated favorable comparability with the Major Trauma Outcome Study (MTOS) database and comparable survival outcomes (Z scores 2.38 and 2.35).

Conclusions:

• The integrated EM/trauma service model demonstrated equivalent survival outcomes regardless of whether EM or surgical housestaff served as team leaders.
• This suggests flexibility in leadership roles within this specific integrated trauma service model.
• Further research may explore long-term impacts and cost-effectiveness of such integrated models.