The cost of trauma center readiness

doi:10.1016/j.amjsurg.2003.06.002

The American Journal of Surgery

Volume 187, Issue 1, January 2004, Pages 7-13

https://doi.org/10.1016/j.amjsurg.2003.06.002 Get rights and content

Abstract

Background

Trauma centers and the services they provide are a unique and necessary component of our health system. By design trauma centers treat all injured patients regardless of their clinical or economic needs. The purpose of this study was to quantify the costs associated with the preparation of the capacity to provide trauma care at trauma centers within the State of Florida.

Methods

Utilizing a survey tool and multiple retreats, we assessed the capability of 20 verified trauma centers throughout the State of Florida. The survey focused on general attributes of each hospital, the costs associated with physician on call coverage, costs associated with verification, and lastly the costs associated with administration, outreach, and prevention.

Results

Data were acquired from 10 trauma centers. Ninety percent of the respondents pay on-call coverage. The median annual physician compensation for on-call coverage was approximately $2.1 million. The total medial cost of readiness for each trauma center approximated $2.7 million annually.

Conclusions

Trauma centers like fire departments and police services are required to be available 24 hours a day, 7 days a week. This level of commitment by trauma centers and the reciprocal expectation from the community force trauma centers to make considerable investments in readiness. This cost of readiness is expended regardless of the patient volume or insurance status. Thus trauma centers have a large component of costs that are not captured by the traditional billing and cost accounting mechanisms within health systems and this fixed expense is extraordinarily difficult to recover given the current reimbursement environment.

Section snippets

Material and methods

An 18-page, 6-section survey was created and distributed to all 20 State of Florida verified trauma centers. The first section focused on background information, including annual patient volume, prehospital transport (ground or air), type of hospital, medical school affiliations, and residency programs. This section also asked whether the trauma centers engaged in such specific “high end” activities as a reimplant service, transplant service, and high-risk obstetrical service. At the hospitals'

Results

Ten of 20 trauma centers responded, including both level I and level II trauma centers, two pediatric trauma centers, a major academic health system, a rural trauma center, and large urban trauma centers. All 10 hospitals completed the first two sections of the survey (relating to background information and physician call coverage). The remaining sections (on reverification costs, registry, registrar, outreach and prevention costs, and other costs) were less complete.

All 10 respondents provided

Comments

Trauma centers are unique community assets requiring substantial ongoing investments simply to ensure “readiness” to provide care. This analysis identifies median annual fixed investments of $2.7 million necessary to carry this out. These expenses are borne even before the first patient arrives, and are never directly billed to individual trauma patients. The largest single expense, a median $2.1 million annually (or $237 per hour), stems from physician stipends. These stipends guarantee nearly

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Factors that enhance continued trauma center participation in trauma systems
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Health Care Advisory Board. Level II trauma centers. January 1999, Washington, D.C., p....

There are more references available in the full text version of this article.

Cited by (70)

Impact of lower level trauma center proliferation on patient outcomes
2024, Surgery Open Science
In attempt to increase trauma system coverage, our state added 21 level 3 (L3TC) and level 4 trauma centers (L4TC) to the existing 7 level 1 trauma centers from 2008 to 2012. This study examined the impact of adding these lower-level trauma centers (LLTC) on patient outcomes.
Patients in the state trauma registry age ≥ 15 from 2007 to 2012 were queried for demographic, injury, and outcome variables. These were compared between 2007 (PRE) and 2008–2012 (POST) cohorts. Multivariate logistic regression was performed to assess independent predictors of mortality. Subgroup analyses were performed for Injury Severity Score (ISS) ≥15, age ≥ 65, and trauma mechanisms.
143,919 adults were evaluated. POST had significantly more female, geriatric, and blunt traumas (all p < 0.001). ISS was similar. Interfacility transfers increased by 10.2 %. Overall mortality decreased by 0.6 % (p < 0.001). Multivariate logistic regression analysis showed that being in POST was not associated with survival (OR: 1.07, CI: 0.96–1.18, p = 0.227). Subgroup analyses showed small reductions in mortality, except for geriatric patients. After adjusting for covariates, POST was not associated with survival in any subgroup, and trended toward being a predictor for death in penetrating traumas (OR: 1.23; 1.00–1.53, p = 0.059).
Unregulated proliferation of LLTCs was associated with increased interfacility transfers without significant increase in trauma patients treated. LLTC proliferation was not an independent protector against mortality in the overall cohort and may worsen mortality for penetrating trauma patients. Rather than simply increasing the number of LLTCs within a region, perhaps more planned approaches are needed.
This is, to our knowledge, the first work to study the effect of rapid lower level trauma center proliferation on patient outcomes. The findings of our analysis have implications for strategic planning of future trauma systems.
A cross-sectional study of trauma certification and hospital referral region diversity: A system theory approach
2021, Injury
Citation Excerpt :
The significant impact of TCs operation costs on the number of TC L-I/II center available may shed light on why we found that competition has a significant impact on trauma certification or the number of L-I/II TCs. Due to their large operational costs, about $2.7 million per year to maintain trauma readiness [31], TC L-I/II certified hospitals require a large amount of financial backing (state-level) and are more of an advantage strategy (skilled staff, community, and state support, and community recognition) in a competitive market [32]. The majority of TC L-I/II financial support at the state-level comes from tax dollars and disproportionate share hospital (DSH) funds.
There are clear racial/ethnic disparities in the trauma care service delivery. However, no study has examined the relationships between structural determinants of trauma care designations (L-I through L-IV) or verification and social factors of the surrounding health region in the U.S.
This study examined the relationship between U.S. community segregation in a hospital referral region (HRR) and hospitals’ attainment of trauma certification and trauma designation L-I/II.
Two-year retrospective analysis of 2,348 acute hospitals that participated in the Hospital Value-Based Purchasing (HVBP) Program. Multivariate Poisson and 1:2 matching ratio using Propensity Score Matching regressions were used. Our primary variables were composite segregation scores for each county—aggregated to the HRR level (n=303)—and hospital performance on the HVBP Program.
Segregated HRRs are 69% and 40% less likely to have an increase in the number of hospitals with trauma care designations L-I/II and trauma certification, respectively. Our matching ratio showed that hospitals with trauma certification or hospitals with trauma care designations L-I/II were more likely to be within HRRs with lower community diversity.
Our findings highlight that system disparities exist in trauma care. Research is needed to determine if other factors, such as resource allocation and reimbursement distribution, impact the availability of trauma facilities.
Quantification of Trauma Center Access Using Geographical Information System–Based Technology
2020, Value in Health
Citation Excerpt :
Nevertheless, providing 24/7 highly specialized trauma care comes at a cost. Year-round TC readiness costs around $2.7 million per TC annually in the Unites States.30 Efficient planning of distribution of TCs could therefore not only lead to better outcomes in patients, but also to more efficient distribution of resources and potentially lower healthcare costs.
There is no generally accepted methodology to assess trauma system access. The goal of this study is to determine the influence of the number and geographical distribution of trauma centers (TCs) on transport times (TT) using geographic information system (GIS)–technology.
Using ArcGIS-PRO, we calculated differences in TT and population coverage in 7 scenarios with 1, 2, or 3 TCs during rush (R) and low-traffic (L) hours in a densely populated region with 3 TCs in the Netherlands.
In all 7 scenarios, the population that could reach the nearest TC within <45 minutes varied between 96% and 99%. In the 3-TC scenario, roughly 57% of the population could reach the nearest TC <15 minutes both during R and L. The hypothetical geographically well-spread 2-TC scenario showed similar results as the 3-TC scenario. In the 1-TC scenarios, the population reaching the nearest TC <15 minutes decreased to between 19% and 32% in R and L.
In the 3-TC scenario, the average TT increased by about 1.5 minutes to almost 21 minutes during R and 19 minutes during L. Similar results were seen in the scenarios with 2 geographically well-spread TCs. In the 1-TC scenarios and the less well-spread 2-TC scenario, the average TT increased by 5 to 8 minutes (L) and 7 to 9 minutes (R) compared to the 3-TC scenario.
This study shows that a GIS-based model offers a quantifiable and objective method to evaluate trauma system access under different potential trauma system configurations. Transport time from accident to TC would remain acceptable, around 20 minutes, if the current 3-TC situation would be changed to a geographically well-spread 2-center scenario.
Blunt versus penetrating trauma: Is there a resource intensity discrepancy?
2019, American Journal of Surgery
Citation Excerpt :
Differences in resource utilization between blunt and penetrating injuries are not well studied, particularly in the United States (US) trauma system. Several European based studies report that blunt trauma admissions generally incur higher hospital associated costs than penetrating trauma admissions.3–6 Comparable data from the United States does not exist.
The rising cost of healthcare requires responsible allocation of resources. Not all trauma centers see the same types of patients. We hypothesized that patients with blunt injuries require more resources than patients with penetrating injuries.
This was a retrospective analysis of all highest-level activation trauma patients at our busy urban Level I Trauma Center over five years. Data included demographics, injuries, hospital charges, and resources used. A p value < 0.05 was significant.
4578 patients were included (2037 blunt and 2541 penetrating). Blunt patients were more severely injured, more often admitted, required more radiographic studies, had longer hospital, intensive care unit, and mechanical ventilation days, and therefore, higher hospital charges.
Within one center, patients with blunt injuries required more resources than those with penetrating injuries. Understanding this pattern will allow trauma systems to better allocate limited resources based on each center's mechanism of injury distribution.
Conservative Management of High-grade Renal Trauma Does Not Lead to Prolonged Hospital Stay
2018, Urology
To evaluate the effect of conservative management of high-grade renal trauma on length of hospitalization, we aim to describe characteristics of patients with high-grade renal trauma that are associated with an increased length of stay (LOS) and the effect of conservative vs surgical management on hospital LOS.
A retrospective review of all patients who suffered unilateral high-grade renal trauma (grade 3 or higher) from September 1977 to August 2012 at San Francisco General Hospital in San Francisco, CA was performed. Patients' demographic information, mechanism of injury, injury grade, data about associated injuries, hospital LOS, and management were collected. Descriptive analysis was performed using chi-square, ordered logistic regression, and linear regression analysis. Multivariable analysis was performed using a Fine-Gray model of competing risks survival analysis, adjusting for trauma type, grade, surgery, associated injury, and complications.
The cohort consisted of 408 patients with high-grade unilateral renal trauma of which 257 patients underwent renal exploration. The adjusted multivariable analysis revealed that trauma type, injury grades, nongenitourinary surgery, associated injuries, and complications were associated with increased hospital LOS (P <.01 for all). Renal exploration compared to conservative management for high-grade renal trauma was not associated with an increased hospital LOS (P = .10).
There is no significant difference between conservative and surgical management of high-grade renal trauma in terms of hospital LOS. Conservative management of high-grade renal trauma does not impact patients' length of hospitalization.
A Geographical Analysis of Access to Trauma Centers from US National Parks in 2018
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Scientific paperThe cost of trauma center readiness

Abstract

Background

Methods

Results

Conclusions

Section snippets

Material and methods

Results

Comments

Factors that enhance continued trauma center participation in trauma systems

J Trauma Injury Infect Crit Care

Scientific paper
The cost of trauma center readiness