Embedding a trauma hospitalist in the trauma service reduces mortality and 30-day trauma-related readmissions.
BACKGROUND: Recognizing the increasing age and comorbid conditions of patients admitted to our trauma service, we embedded a hospitalist on the trauma service at our Level I trauma center.This program was initiated in January 2013. This study was designed to investigate differences in outcomes between trauma patients who received care from the trauma hospitalist (THOSP) program and similarly medically complex trauma patients who did not receive THOSP care.
METHODS: There were 566 patients comanaged with THOSP between December 2013 and November 2014. These patients were matched (1:2) with propensity scores to a contemporaneous control group based on age, Injury Severity Score (ISS), and comorbid conditions. Outcomes examined included mortality, trauma-related readmissions, upgrades to the intensive care unit, hospital length of stay, the development of in-hospital complications, and the frequency of obtaining medical subspecialist consultation. Differences in outcomes were compared with Mann-Whitney U-test or χ test as appropriate.
RESULTS: High-quality matching resulted in the loss of 97 THOSP patients for the final analysis. Table 1 shows the balance between the two groups after matching. While there was a 1-day increase in hospital length of stay and an increase in upgrades to the intensive care unit, there was a reduction in mortality, trauma-related readmissions, and the development of renal failure after implementation of the THOSP program (Table 2). Implementation of this program made no significant difference in the frequency of cardiology, nephrology, neurology, or endocrinology consultations. There was also no difference in the development of the complications of venous thromboembolism, pneumonia, stroke, urinary tract infection, bacteremia, or alcohol withdrawal.
CONCLUSION: Our study provides evidence that embedding a hospitalist on the trauma service reduces mortality and trauma-related readmissions. A reason for these improved outcomes may be related to THOSP "vigilance."
LEVEL OF EVIDENCE: Therapeutic/care management study, level IV.
Published In/Presented At
Cipolle, M. D., Ingraham Lopresto, B. C., Pirrung, J. M., Meyer, E. M., Manta, C., Nightingale, A. S., Robinson, E. J., & Tinkoff, G. H. (2016). Embedding a trauma hospitalist in the trauma service reduces mortality and 30-day trauma-related readmissions. The journal of trauma and acute care surgery, 81(1), 178–183. https://doi.org/10.1097/TA.0000000000001062
Medicine and Health Sciences
Department of Surgery