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APHA Scientific Session and Event Listing

Recorded presentation

Mary-Kate Barrette-Grischow, MA, Bruce Ziran, MD, Linda Silvestri, MPH, CHES, and Kenneth Ransom, MD. Orthopaedic Trauma Research, St. Elizabeth Health Center, 1044 Belmont Avenue, Youngstown, OH 44501, 330-480-6302, Mary-Kate_Barrette-Grischow@HMIS.ORG

Purpose: This study examines the variation in services provided among Level I trauma centers across the US. In particular, we tried to determine what resources are available at each responding center and if all level I centers offer the same echelon of services.

Methods: A three-page questionnaire was administered to trauma coordinators at 136 Level I centers in 37 states, which were identified by the American College of Surgeons (ACS) and Bishop and Associates. We queried variances in trauma, neurosurgery, plastics, and orthopaedic surgery with regard to number and training of participating physicians, dedicated OR support (rooms and staff), call pay, and research. Statistical analysis was completed using SPSS Software.

Results: Of the 136 centers surveyed, 39% did not have ACS accreditation. Those without ACS certification were identified as level I trauma facilities by state, county, or district level government. Nearly 90% of centers have active trauma research programs.

66% of level I centers surveyed are university-based facilities that employ more surgeons and ancillary staffing across trauma and all subspecialties compared to public centers.

Orthopaedics: 91% of university-affiliated centers provide in-house orthopaedic trauma services 24/7, compared to only 63% of community-based centers and 60% of public centers, respectively. 70% do not have a dedicated orthopaedics staff; 71% lack a dedicated orthopaedic OR; and 33% do not employ fellowship-trained surgeons.

Neurosurgery: 86% of university-affiliated centers provide in-house neurosurgery services 24/7, compared to only 53% of community-based centers and 50% of public centers, respectively. 70% do not have a dedicated neurosurgery staff and 59% do not provide call pay.

Plastic Surgery: 69% of university-affiliated centers provide in-house plastic surgery services 24/7, compared to only 50% of community-based centers and 50% of public centers, respectively. 87% do not have a dedicated plastic surgery staff and 77% do not provide call pay.

Conclusions: There are wide variances of provided services across level I centers and there is no single standard accreditation process for every facility. 39% of centers do not have ACS certification and rely on endorsement from state, county, or local government. Further, only ¼ of level I centers provide specific staffing with expertise in each subspecialty and less than ½ of centers provide on-call pay for subspecialty surgeons. Our analysis provides evidence that academic centers have superior assets available and provide more extensive support. While implying inconsistency in delivered care, such resource differentials may ultimately impact the efficacy and cost-effectiveness of treatment.

Learning Objectives: At the conclusion of this session, the participant will be able to

• Recognize that there are differences in services provided by level I trauma centers across the United States.
• Identify the different accreditation processes for level I trauma status.
• Assess the resource diparities between university-affiliated, community-based, and public level I facilities.

Keywords: Health Care Delivery, Health Care Quality

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation