• Injury · Jan 2019

    Comparative Study

    Severely injured patients benefit from in-house attending trauma surgeons.

    • van der Vliet Quirine M J QMJ University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands. Electronic address: q.m.j.vandervliet@umcutrecht.nl., Oscar E C van Maarseveen, Smeeing Diederik P J DPJ University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands. Electronic address: d.p.j.smeeing@umcutrecht.nl., Roderick M Houwert, van Wessem Karlijn J P KJP University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands. Electronic address: kwessem@umcutrecht.nl., Simmermacher Rogier K J RKJ University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands. Electronic address: r.k.j.simmermacher@umcutrecht.nl., Govaert Geertje A M GAM University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands. Electronic address: g.a.m.govaert@umcutrecht.nl., Mirjam B de Jong, Ivar G J de Bruin, Leenen Luke P H LPH University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands. Electronic address: l.p.h.leenen@umcutrecht.nl., and Falco Hietbrink.
    • University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands. Electronic address: q.m.j.vandervliet@umcutrecht.nl.
    • Injury. 2019 Jan 1; 50 (1): 20-26.

    IntroductionThere is continuous drive to optimize healthcare for the most severely injured patients. Although still under debate, a possible measure is to provide 24/7 in-house (IH) coverage by trauma surgeons. The aim of this study was to compare process-related outcomes for severely injured patients before and after transition of attendance policy from an out-of-hospital (OH) on-call attending trauma surgeon to an in-house attending trauma surgeon.MethodsRetrospective before-and-after study using prospectively gathered data in a Level 1 Trauma Center in the Netherlands. All trauma patients with an Injury Severity Score (ISS) >24 presenting to the emergency department for trauma before (2011-2012) and after (2014-2016) introduction of IH attendings were included. Primary outcome measures were the process-related outcomes Emergency Department length of stay (ED-LOS) and time to first intervention.ResultsAfter implementation of IH trauma surgeons, ED-LOS decreased (p =  0.009). Time from the ED to the intensive care unit (ICU) for patients directly transferred to the ICU was significantly shorter with more than doubling of the percentage of patients that reached the ICU within an hour. The percentage of patients undergoing emergency surgery within 30 min nearly doubled as well, with a larger amount of patients undergoing CT imaging before emergency surgery.ConclusionsIntroduction of a 24/7 in-house attending trauma surgeon led to improved process-related outcomes for the most severely injured patients. There is clear benefit of continuous presence of physicians with sufficient experience in trauma care in hospitals treating large numbers of severely injured patients.Copyright © 2018 Elsevier Ltd. All rights reserved.

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