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Throughput analysis of trauma resuscitations with financial impact |
Imami E R, Clevenger F W, Lampard S D, Kallenborn C, Tepas J J |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Trauma management with co-ordinated physician-hospital patient care groups (PCGs) and physician education intervention regarding resource use.
Economic study type Cost-effectiveness analysis.
Setting The setting was an adult and pediatric Level I trauma centre with 5 acute resuscitation bays, Department of Surgery, University of Florida Health Science Centre, Jacksonville, Florida, USA.
Dates to which data relate Effectiveness and cost data were collected between 14 July 1994 and 30 June 1995 (data for the comparator were collected between July and December 1994, whereas data for the intervention strategies were collected between January and March 1995 and from April to June 1995). The price year was not clearly reported.
Source of effectiveness data Effectiveness data were derived from a single study.
Link between effectiveness and cost data Costing was undertaken retrospectively on the same patient sample as that used in the effectiveness analysis.
Study sample Although no power calculations were reported, there were 2,546 resuscitations: 1,201 in group I, 636 in group II, and 709 in group III. Group I consisted of patients resuscitated between July 14 and December 31, 1994, and served as control. Factors (a) (coordinated physician-hospital patient care) and (b) (increasing physician education regarding resources) were implemented in January 1995, so individuals resuscitated between 1 January and 31 March 1995, formed group II. Factor (c) (in-house trauma attending call) was implemented on 1 April 1995; therefore resuscitations from 1 April to 30 June 1995 made up group III.
Study design Observational cohort study with nonconcurrent controls from a single centre. The duration of follow-up was until hospital discharge.
Analysis of effectiveness The analysis of effectiveness was based on treatment completers only. The main outcomes used in the analysis were throughput in the resuscitation bay and mortality. The groups were similar with respect to mean triage level, Injury Severity Score, age, gender mix and injury mechanisms.
Effectiveness results Factors (a) and (b) together and factor (c) improved throughput in the resuscitation bay by approximately 35% (5-133 minutes) each. The gross mortality was: 10% in group I, 7% in group II, and 7% in group III.
Measure of benefits used in the economic analysis Throughput in the resuscitation bay and mortality.
Direct costs The resource use associated with disposition and resuscitation time was analysed separately from the costs. Direct health service costs (e.g. hospital costs) were considered. Charge data were obtained retrospectively from the managerial accounting office on all adult trauma hospital discharges. Hospital cost was calculated by multiplying charges at the time of discharge with an average cost to charge ratio of 0.40 (which was a weighted average of department specific cost to charge ratios). The price year was not clearly reported.
Statistical analysis of costs Statistical comparisons were made using analysis of variance and Fisher's exact test.
Sensitivity analysis No sensitivity analysis was performed.
Estimated benefits used in the economic analysis Factors (a) and (b) together and factor (c) improved throughput in the resuscitation bay by approximately 35% (5-133 minutes) each. The gross mortality was: 10% in group I, 7% in group II, and 7% in group III.
Cost results The mean hospital cost per patient was $14,045 in group I, $13,893 in group II and $9,956 in group III (p<0.001 for all comparisons).
Synthesis of costs and benefits The costs and benefits were not combined since the intervention (strategy III) turned out to be dominant.
Authors' conclusions A collaborative hospital-physician patient care programme and physician awareness of resource use significantly improved the timeliness of initial hospital care for severely injured patients. The addition of in-house trauma surgical staff appears to have enhanced this effect. The cumulative result of these efforts was a decrease in hospital costs with no rise in mortality.
CRD COMMENTARY - Selection of comparators The reason for the choice of the comparator (in this case trauma management before the introduction of co-ordinated physician-hospital patient care groups plus physician awareness of resource use and in-house trauma surgical staff) is clear, as this was a widely used health technology in the authors' setting. You, as a database user, should consider if this applies to your own setting.
Validity of estimate of measure of benefit Although the choice ofoutcomes is justified the study design selected is likely to jeopardise the results (historical controls were used).
Validity of estimate of costs Although the main quantities of resource use were analysed separately from costs, charges were the primary data collected, and these were transformed using a weighted average cost-to-charge ratio. The price year was not clearly stated.
Other issues Given the uncertainties in the data, the conclusions of this study are debatable.
Bibliographic details Imami E R, Clevenger F W, Lampard S D, Kallenborn C, Tepas J J. Throughput analysis of trauma resuscitations with financial impact. Journal of Trauma 1997; 42(2): 294-298 Indexing Status Subject indexing assigned by NLM MeSH Adult; Female; Florida; Health Care Rationing; Hospital Costs; Hospitals, University; Humans; Male; Middle Aged; Resuscitation /utilization; Time Factors; Trauma Centers /economics /organization & Triage; Wounds and Injuries /economics /therapy; administration AccessionNumber 21997000426 Date bibliographic record published 31/10/1998 Date abstract record published 31/10/1998 |
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