• William O Cooper, Gerald B Hickson, Oscar D Guillamondegui, Jeremy W Cannon, Anthony G Charles, J Jason Hoth, Hasan B Alam, Areti Tillou, Frederick A Luchette, Dionne A Skeete, Henry J Domenico, J Wayne Meredith, Theresa M H Brennan, Brian P Smith, Rachel R Kelz, Ben E Biesterveld, Ashley Busuttil, Jeffrey K Jopling, Joseph R Hopkins, Cynthia L Emory, Patricia G Sullivan, R Shayn Martin, Russell M Howerton, Henry M Cryer, Heather A Davidson, Richard P Gonzalez, and David A Spain.
• Center for Patient and Professional Advocacy, Vanderbilt University Medical Center, Nashville, TN.
• Ann. Surg. 2022 May 1; 275 (5): 883-890.

ObjectiveTo determine whether trauma patients managed by an admitting or consulting service with a high proportion of physicians exhibiting patterns of unprofessional behaviors are at greater risk of complications or death.Summary Background DataTrauma care requires high-functioning interdisciplinary teams where professionalism, particularly modeling respect and communicating effectively, is essential.MethodsThis retrospective cohort study used data from 9 level I trauma centers that participated in a national trauma registry linked with data from a national database of unsolicited patient complaints. The cohort included trauma patients admitted January 1, 2012 through December 31, 2017. The exposure of interest was care by 1 or more high-risk services, defined as teams with a greater proportion of physicians with high numbers of patient complaints. The study outcome was death or complications within 30 days.ResultsAmong the 71,046 patients in the cohort, 9553 (13.4%) experienced the primary outcome of complications or death, including 1875 of 16,107 patients (11.6%) with 0 high-risk services, 3788 of 28,085 patients (13.5%) with 1 high-risk service, and 3890 of 26,854 patients (14.5%) with 2+ highrisk services (P < 0.001). In logistic regression models adjusting for relevant patient, injury, and site characteristics, patients who received care from 1 or more high-risk services were at 24.1% (95% confidence interval 17.2% to 31.3%; P < 0.001) greater risk of experiencing the primary study outcome.ConclusionsTrauma patients who received care from at least 1 service with a high proportion of physicians modeling unprofessional behavior were at an increased risk of death or complications.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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