Trauma care inside and outside business hours: comparison of process quality and outcome indicators in a German level-1 trauma center

Parsch, Wolfgang; Loibl, Markus; Schmucker, Uli; Hilber, Franz; Nerlich, Michael; Ernstberger, Antonio

doi:10.1186/preaccept-9958039751310624

Cited by 2 publications

(4 citation statements)

References 32 publications

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“…This phenomenon is termed the off-hour effect . Previous reports have shown that, if patients are treated at a level I trauma center in a mature trauma-care system, mortality rates of those presenting during off hours are not worse than those of patients presenting during business hours [ 9 - 14 ]. A level I trauma center [ 15 ] has the highest concentration of medical resources, including 24-hour availability of in-house surgeons, anesthesiologists, and interventional radiologists.…”

Section: Introductionmentioning

confidence: 99%

The off-hour effect on trauma patients requiring subspecialty intervention at a community hospital in Japan: a retrospective cohort study

Ono

Ishida

Iwasaki

et al. 2015

Scand J Trauma Resusc Emerg Med

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BackgroundBecause most community hospitals in Japan do not maintain 24-h availability of in-house anesthesiologists, surgeons, and interventional radiologists, staffing dramatically declines during off hours. It is unclear whether, in such under-resourced hospitals, trauma patients presenting during off hours and requiring subspecialty intervention have worse outcomes than those who present during business hours.MethodsThis was a retrospective cohort study at a community hospital in Japan. Participants were all injured patients requiring emergency trauma surgery or transarterial embolization who presented from January 2002 to December 2013. We investigated whether outcomes of these patients differed between business hours (8:01 AM to 6:00 PM weekdays) and off hours (6:01 PM to 8:00 AM weekdays plus all weekend hours). The primary outcome measure was mortality rate, and the secondary outcome measures were duration of emergency room (ER) stay; unexpected death (death/probability of survival > 0.5); and adverse events occurring in the ER. We adjusted for potential confounders of age, sex, Injury Severity Score (ISS), Revised Trauma Score, presentation phase (2002–2005, 2006–2009, and 2010–2013), Charlson Comorbidity Index, and injury type (blunt or penetrating) using logistic regression models.ResultsOf the 805 patients included, 379 (47.1%) presented during business hours and 426 (52.9%) during off hours. Off-hours presentation was associated with longer ER stays for patients with systolic blood pressure < 90 mmHg on admission (p = 0.021), ISS >15 (p = 0.047), and pelvic fracture requiring transarterial embolization (p < 0.001). Off-hours presentation was also associated with increased risk of adverse events in the ER (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1–2.7, p = 0.020). After adjustment for confounders, an increased risk of adverse events (OR 1.6, 95% CI 1.1–2.7, p = 0.049) persisted, but no differences were detected in mortality (p = 0.80) and unexpected death (p = 0.44) between off hours and business hours.ConclusionsAt a community hospital in Japan, presentation during off hours was associated with a longer ER stay for severely injured patients and increased risk of adverse events in the ER. However, these disadvantages did not impact mortality or unexpected outcome.

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Section: Introductionmentioning

confidence: 99%

The off-hour effect on trauma patients requiring subspecialty intervention at a community hospital in Japan: a retrospective cohort study

Ono

Ishida

Iwasaki

et al. 2015

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

show abstract

“…They found no difference in 24-h mortality and inhospitable mortality. [15] However, the study had a small sample size in comparison to ours (394 vs. 4691), the definition of during-hours and after-hours was also different, they defined business hours (during-hours) from 8 am to 4 pm, while we defined during-hours from 8 am to 6 pm, and after-hours from 6 to 8 am morning (nonbusiness hours, 4–8 am). It may also be due to different trauma systems which exist between the developed systems of care and developing nations.…”

Section: Discussionmentioning

confidence: 80%

“…Trauma systems also exhibit discrepancies in the performance based on the timing of arrival to the hospital. [151617] Processes of care may show fluctuations across different time periods. However, there is considerable inconsistency in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Do the care process and survival chances differ in patients arriving to a level 1 Indian trauma center, during-hours and after-hours?

Soni

Mahindrakar

Kaushik

et al. 2019

J Emerg Trauma Shock

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Introduction: Trauma systems vary in performance during different time periods and may affect the patient outcomes, especially in resource-limited settings. The present study was undertaken to study the pattern, epidemiological profile, processes of care variations of trauma victims presenting during-hours and after-hours in a level 1 trauma Center of a lower middle-income country. Methodology: Retrospective analyses of prospectively collected data registry at a single tertiary care center. Data collected from 2013 to 2015 were analyzed. Patients with a history of trauma and admission to the center or death between arrival and admission were included. Isolated limb injury and patients dead on arrival were excluded. Results: Of 4692, 1789 (38.1%) patients arrived and were admitted during-hours and 2903 (61.9%) after-hours. The overall in-hospital mortality was 14.9% in the cohort. Moreover, it was 16.10% during after-hours in comparison to 13.0% during-hours. The Revised Trauma Score was statistically different during-hours and after-hours suggesting patients with greater physiological derangement after-hours. The Kaplan–Meier survival curves for 7 days were comparable in two groups with the log-rank test of 078. The proportion of initial radiological investigations (chest X-ray, focused assessment sonography in trauma [FAST], and computerized tomography [CT] scans) was ranged from 84.9% for CT scans in the cohort to 99.3% for FAST. Conclusions: Processes of care do not differ significantly for the patients admitted at a level 1 trauma center irrespective of time of the day. Although survival probability for the initial 7 days of follow-up is comparable between two groups; however, for 30 and 90 days of follow-up they are significantly different between during-hours and after-hours, likely due to injury severity.

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Trauma care inside and outside business hours: comparison of process quality and outcome indicators in a German level-1 trauma center

Cited by 2 publications

References 32 publications

The off-hour effect on trauma patients requiring subspecialty intervention at a community hospital in Japan: a retrospective cohort study

The off-hour effect on trauma patients requiring subspecialty intervention at a community hospital in Japan: a retrospective cohort study

Do the care process and survival chances differ in patients arriving to a level 1 Indian trauma center, during-hours and after-hours?

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