Neurosurgical trauma call: use of a mathematical simulation program to define manpower needs

Resource criteria for trauma centers (TC) mandate a first plus backup neurosurgeon (NS) coverage, an unnecessary expense for TC treating few neurosurgery patients. This report uses a mathematical modeling system to define optimal NS trauma coverage. Random data from 749 patients treated with emergency neurosurgery operations (OR) within 24 hours of admission at 97 TC were used to create a 1-year profile of admission by month, day, and hour, operation times, and operation duration. These data were entered into a simulation program to define the frequency that a patient needing a NS consult would wait beyond 30 minutes because the NS was in the operating room at a trauma center with one, two, or three neurosurgeons on-call. One thousand iterations were done for each sample size of 25 to 300 patients in 25-patient increments. The probability that a patient could not be seen promptly by one NS in a trauma center operating on 25, 50, 75, or 100 patients per year is 0.23, 0.9, 1.6, and 3.66 patients per year. Fewer than one patient (0.75) per year will wait more than 30 min in a trauma center doing 225 emergency ORs when two neurosurgeons are on-call. One patient in 10 years would wait more than 30 min in a trauma center doing 300 ORs with a third NS on-call. Mathematical modeling of patient data helps define optimal hospital resources. Mandatory NS backup for TC performing fewer than 25 neurosurgery procedures is unneeded.