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Defining Excess Resource Utilization and Identifying Associated Factors for Trauma Victims

O'Keefe, Grant E. MD; Jurkovich, Gregory J. MD; Maier, Ronald V. MD

The Journal of Trauma: Injury, Infection, and Critical Care: March 1999 - Volume 46 - Issue 3 - p 473-478
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Background Trauma system evaluation addresses aspects of the process, structure, and outcomes of trauma care. This approach may not identify all opportunities for trauma system improvement. Hospital length of stay (LOS) represents a meaningful measure of resource utilization and may help focus efforts to improve care. The purpose of this study is to estimate expected hospital LOS after trauma and determine the consequences of excessive LOS.

Methods Patients admitted during a 2-year period (January 1, 1993 to December 31, 1994) were retrospectively reviewed, and expected LOS was estimated. Excess LOS was defined as an observed LOS >or=to 100% of expected. Injuries, complications, and American College of Surgeons' Committee on Trauma audit filters were compared between the groups.

Results Observed LOS exceeded expected by 100% or more for 568 of 5,226 patients (10.9%), and most survived (98.3%). Complications predicted excess LOS, whereas audit filters did not. Median costs for these 568 patients were $30,315 and totaled 30% of the expenditures for the entire cohort of 5,226 patients.

Conclusion Prolonged LOS represents an adverse outcome. Estimation of LOS and evaluation of outliers represents an important method for the evaluation of care within established trauma systems and centers.

From the Department of Surgery (G.E.O.), University of Texas, Southwestern Medical Center, Dallas, Texas; and the Department of Surgery (G.J.J., R.V.M.), University of Washington, Seattle, Washington.

Address for reprints: Grant E. O'Keefe, Department of Surgery, University of Texas, Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9158; e-mail: gokeef@mednet.swmed.edu.

© 1999 Lippincott Williams & Wilkins, Inc.