The effect of initiation of an orthopedic trauma service on patient outcomes and clinical enterprise financial performance

Abstract

Background: As the demands of patients and the health-care reimbursement system continue to change rapidly, hospitals and surgeons are adopting new methods of delivering high-quality care at a lower cost. To this end, the use of a daily, dedicated orthopedic trauma room has been increasing in popularity. Our institution, a major Level I academic trauma center, however, has been a late adopter, only starting a dedicated orthopedic trauma room on November 1, 2013. The purpose of this retrospective data review was to assess the clinical (intensive care unit [ICU] length of stay [LOS] and hospital LOS) and financial outcomes of a dedicated trauma room. Design: This is a retrospective analysis of pre- and post-intervention measures of patient outcomes and financial performance using archival data from a trauma registry linked to cost, charge, and payment records. Methods: Our trauma registry was used to identify admission of patients requiring surgery for orthopedic injuries involving the lower extremity from the hip to the ankle for 11 months preceding the adoption of a daily trauma room (pre) and 11 months following its implementation (post). We compared pre- and post-hospital LOS and ICU LOS, while controlling for the effect of race, age, gender, Injury Severity Score (ISS), and type of insurance. There were 243 eligible patients identified for the “post” group and 258 in the “pre” group. Results: We found no statistically significant difference between the groups in mean age, ISS, or in distribution of patient sex or race. The estimated mean LOS (controlling for patient characteristics) was 8.35 days in the “pre” group and 7.79 days in the “post” group. This represented a statistically significant reduction (P Conclusions: These findings represent a significant improvement over the previous system and have implications for overall patient outcomes and also financial outcomes. Other studies have suggested that decreased total hospital and ICU stay have both been associated with overall better patient outcomes. Furthermore, the decreased LOS, especially in the ICU, frees scarce capacity in an institution experiencing a chronic shortage of available ICU beds. Our study illustrates the importance of capturing both resource use (such as bed days) and cost when evaluating the effect of process improvements in large hospitals. Costs and revenue measures alone may not capture the true economic benefits of process improvements in institutions where resources that are freed up by one service may be used by other service lines.