Impact of Multiple-Service Coverage Shifts on Quality and Safety in Trauma Care

Abstract

At many trauma centers in the United States, one acute care surgeon is responsible for overnight coverage of both the emergency general surgery (EGS) and trauma services. The impact of this scheduling phenomenon on the quality and safety of care has not been studied. Overnight trauma admissions to an academic Level I trauma center from 2013 to 2015 were studied. Admissions were divided into two groups based on whether the admitting surgeon covered only the trauma service (‘single-call') or both the trauma and EGS services (‘multiple-service call'). Four major outcomes (eg mortality and length of stay), 5 quality metrics (eg time to first OR visit and unplanned transfers to the ICU), and procedural utilization patterns were compared. A total of 1,046 admissions were studied. Between single-call and multiple-service call admissions, there were no differences in any major outcomes. Quality metrics dependent on the admitting surgeon remained unchanged, including attending timeliness to Level 1A activations (93% vs 86%, p=0.07) and time to first OR visit (331 minutes vs 363 minutes, p=0.3). There were no differences in the number of laboratory and imaging studies performed per patient by the admitting surgeon (2.9 vs 3.0, p=0.4). Admissions done by surgeons on multiple-service call had similar outcomes, quality metrics, and procedural utilization patterns compared to admissions done by single-call surgeons. Despite concerns that multiple-service call may be overburdening, time-dependent quality metrics and studies done during the initial workup remained unchanged. These findings suggest that simultaneous trauma and EGS service coverage by one surgeon is generally safe.