Effect of Traumatologist Coverage of Emergency Room Orthopedic Call at a Community Hospital

Abstract

OBJECTIVES:

To understand the effect of dedicated Emergency Room (ER) orthopedic call coverage by trauma-trained orthopedic surgeons (TTOS), rather than non-trauma-trained orthopedic surgeons (NTTOS), at a non-trauma-designated community hospital.

METHODS

Design: retrospective review

Setting: Non-trauma-designated hospital

Patients/Participants: All ER patients admitted for operative orthopedic intervention in the 12 months before (baseline period) and after (study period) implementation of dedicated ER coverage by TTOS.

Outcome Measures and Comparisons: ER-to-OR time, frequency of nighttime surgery (cases starting after 5pm), transfers for higher level of care, and several hip fracture outcomes (ER-to-OR time, case duration, implant costs, and length of stay [LOS] postoperatively).

RESULTS

ER coverage by TTOS resulted in more call cases (464 vs 280), fewer transfers (4 vs 19), decreased nighttime surgery (4.84% vs 35.71%), decreased implant costs ($2573 vs $3129), and decreased OR supply costs ($391 vs $498).  For hip fractures, there was a statistically-significant decrease in ER-to-OR time (23.7 vs 33.4 hours [p<0.001]), case duration (pinning 24.4 vs 33.3 minutes [p=0.006], nailing 33.4 vs 59.8 minutes [p<0.001], hemiarthroplasty 53.0 vs 72.9 minutes [p<0.001]), implant costs (pinning $608 vs $1,879 [p<0.001], nailing $1,704 vs $4,138 [p<0.001], hemiarthroplasty $3,273 vs $3,381 [p=0.577]), and LOS (5.47 vs 6.40 days).

There was no significant difference in reoperation rates (NTTOS 3.56%, TTOS 4.53%).

Figure 1 summarizes NTTOS ER coverage and TTOS ER coverage.

CONCLUSIONS

Orthopedic emergency room call coverage at a non-trauma-designated hospital by trauma-trained orthopedic surgeons, rather than non-trauma-trained orthopedic surgeons, offered significant clinical and economic benefit.

LEVEL OF EVIDENCE

Level III