A. V. Jambhekar1, T. Liu1, R. Lee1, B. Fahoum1, M. Zenilman1, J. Rucinski1 1New York Presbyterian Brooklyn Methodist Hospital,Surgery,Brooklyn, NY, USA
Introduction: Unnecessary admissions to higher levels of care are an inappropriate use of limited hospital resources and in newly developed trauma centers, patients may be admitted to err on the side of caution. Our hypothesis was to determine if use of a trauma checklist can deter unnecessary admissions to higher levels of care and therefore serve as an important cost saving measure.
Methods: Data was collected on 1783 trauma patients admitted between April 1, 2015 and April 1, 2017. The patients were divided into 2 groups—pre checklist (n=198) and post checklist (n=1585). Injury Severity Score (ISS), mechanism of injury, and admission disposition were compared using unpaired student t tests and Fisher’s exact test.
Results: The pre checklist group had higher percentages of activations and penetrating trauma. In the pre checklist group, 21.2% of patients were admitted to the Surgical Intensive Care Unit (SICU) and 47.5% were admitted to the Surgical Stepdown Unit (SSD) compared to 9.4% and 27.6% respectively post checklist (p < 0.0001). The overall ISS decreased (7.0 +/- 5.6 vs. 5.7 +/- 7.1, p = 0.01) but the ISS of patients admitted to higher levels of care trended up (Table 1). There were no upgrades from the floor to higher levels of care in either group. At an average cost of $4,400 per night for a floor bed, $5720 per SSD bed, and $9130 per SICU bed, the use of the trauma checklist saved the hospital approximately $3,510,362.9 in admission costs alone.
Conclusion: The trauma checklist organizes the initial evaluation of trauma patients leading to fewer unnecessary admissions to higher levels of care leading to more appropriate allocation of healthcare resources and decreased hospital costs.
