Background : The purpose of this study was to evaluate process and outcome quality of severely injured patients admitted during on-call (OC) versus regular trauma service (RS).
Methods : This was a prospective and multicentric analysis of the Trauma Registry of the German Trauma Society. Patients were evaluated if directly admitted from the scene of accident with an Injury Severity Score of > 15 and if alive on arrival at the emergency department.
Results : Seventy percent of patients were admitted during OC; these patients were significantly younger. Blunt trauma predominated, with a 95% incidence. Falls from great heights were significantly more frequent during RS, whereas motor vehicle crashes predominated during OC. No differences were found for emergency department management (e.g., time to abdominal ultrasound, chest radiograph, or cranial computed tomography). However, time to admission to the intensive care unit was substantially longer during RS. No significant differences were found for outcome parameters such as length of intensive care unit stay, hospitalization time, incidence of organ failure, or mortality.
Conclusion : This study demonstrates a constant quality of care provided 24 hours per day, 7 days per week in the participating hospitals. Differences within individual trauma centers were not compared and need to be assessed by internal quality management.
The rate of preventable trauma deaths in the United States has been drastically reduced by the introduction of specialized trauma centers in the past decade. 1-7 The patient care in these centers has been shown to increase survival and outcome even if a longer transportation time was conceded to reach the center instead of a regional hospital. 6 Therefore, the additional use of air rescue services is often recommended. 8 The reasons for an increase in quality of care in trauma centers include competent, experienced, and dedicated trauma teams and improved structural resources such as blood depots, operating room capacities, and higher diversification of the faculties. Consequently, mortality of trauma patients was reduced by 16% to 31%, depending on injury severity. 2-7,9-12 Major in-hospital complications such as missed diagnoses have been shown to be strongly associated with excess resource use; increased length of stay, mortality, and costs; and reduced functional long-term outcome and quality of life in trauma patients. 13-18
The annual national direct costs of motor vehicle-related injuries in the United States are estimated at $12 billion. The acute treatment of one critically injured patient in Germany costs approximately $50,000, with the major cost factor being the human resources. 19,20
To our knowledge, there are no existing studies that have evaluated the extent to which process and outcome quality are associated with admission of the patient during regular versus on-call trauma service in German trauma centers. This study was designed to analyze differences in the quality of care between regular versus on-call trauma service and thereby to evaluate whether this enormous effort in terms of human and financial resources is justified in the face of the economic situation of the German health care system.