Trauma patients: you can get them in, but you can’t get them out

• Published in: The American journal of surgery 2008, Vol.195 (1), p.78-83
• Main Authors: Ciesla, David J., M.D, Sava, Jack A., M.D, Kennedy, Susan O, Levinson, Karen, M.S.W, Jordan, Marion H., M.D
• Format: Article
• Language: English
• Subjects: Adult; Aftercare - utilization; Biological and medical sciences; Cross-Sectional Studies; District of Columbia; Emergency services; Female; General aspects; Health Care Rationing - organization & administration; Health Resources - utilization; Hospitals; Humans; Intensive Care Units - utilization; Length of stay; Length of Stay - statistics & numerical data; Male; Medical sciences; Middle Aged; Patient Discharge - statistics & numerical data; Patients; Registries; Subacute Care; Surgery; Throughput; Time Factors; Trauma; Trauma centers; Trauma Centers - utilization; Trauma Severity Indices; Utilization Review; Wounds and Injuries - diagnosis; Wounds and Injuries - rehabilitation; Wounds and Injuries - therapy
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2007.05.037

Abstract Background The majority of inpatient trauma care resources are consumed by a small proportion of severely injured patients. Methods Hospital lengths of stay (LOS), resource consumption, and postdischarge placement were abstracted from the institutional trauma registry. Results Patients (n = 4,070) were evaluated by the trauma service during the study period. The overall mean LOS was 4.4 days, and beds were occupied on 18,005 days. Two hundred forty-four (6%) patients remained in the hospital >14 days after injury and occupied beds on 8,560 (47%) days. These patients were older, more severely injured, and required proportionately more intensive care unit and operative care. Injuries to the head, abdomen, and extremities were independently associated with longer LOS. Most patients with longer LOS were placed in long-term acute care or received home nursing care after discharge. Conclusions Almost half of inpatient trauma bed-days are occupied by a small proportion of patients with long-term care needs.