ABSTRACT: Although previous studies have investigated the impact of weather and temporal factors on incidence of trauma admissions, there is a paucity of data describing the effect of seasonal change on burn injury. The purpose of this study was to examine the impact of the changing seasons on admissions to and resource utilization at an accredited burn center, with the goal of optimizing patient throughput and matching supply with demand.
We performed a retrospective review of all burn admissions to an accredited, regional burn center, from Summer 2009 through Spring 2010. Patients were segregated into the seasonal cohorts of Summer, Fall, Winter, and Spring, based on admission date. Patient demographics included age, gender, mechanism of injury, and total body surface area (TBSA) injured. Main outcome measures included length of intensive care unit (ICU) stay, length of stay (LOS), and hospital charges, which served as a proxy for resource utilization (nursing, wound, and critical care; access to operating room (OR); inpatient rehabilitation). Groups were compared by T tests, with statistical significance assigned to P values <0.05.
Seven hundred thirty patients were admitted to the burn center during this annual period, with a mean age of 31.6 years and a TBSA of 8.9%. Although Spring had the greatest the number of admissions at 219 (30%), patients from Summer and Winter had the largest burns, longest length of ICU and hospital stays, and highest hospital charges (P < 0.05). Furthermore, variability of these parameters, as measured by standard deviation, was greatest during Summer and Winter, serving to reduce throughput via uneven demand on resources. Highest throughput occurred during the Spring, which had the highest admission-to-LOS ratio. No differences were observed in age, gender, and incidence of electrical injuries, across the 4 seasons.
Summer and winter were the peak seasons of resource utilization at our burn center, in terms of length and variability of ICU and hospital stays, as well as total hospital charges. Such seasonal change may be related to acuity of burn injury but not number of burn admissions. To improve operational efficiency and maximize patient throughput, resource allocation should be structured to anticipate seasonal changes, so that supply of services matches demand.
Annals of plastic surgery 05/2012; 69(1):30-4. · 1.29 Impact Factor
ABSTRACT: Despite improvements in automotive safety, motor vehicle collision (MVC)-related facial fractures remain common and represent preventable injuries. This study examines the changing characteristics of facial fractures treated at a regional, level I trauma center, from 2005 to 2010.
We identified all patients with facial fractures admitted to our hospital, from 2005 to 2010, by querying the North Carolina Trauma Registry, using International Classification of Diseases, Ninth Revision codes. Prospectively collected data, sorted by year, were descriptively analyzed for demographics, referral patterns, etiology, anatomic location, and clinical outcomes.
Number of patients with facial fractures increased from 201 per year to 263 per year (total n = 1508). Although transport distances remained constant at ∼85 miles, standard deviation increased from 37 to 68 miles. Transport time increased from 87 to 119 minutes. Referrals came from 28 surrounding counties in 2005 and 43 counties in 2010. Regarding etiology, MVCs decreased from 40% to 27%, all-terrain vehicle crashes decreased from 6% to 2%, falls increased from 8% to 19%, and bicycle accidents increased from 3% to 6%. Regarding anatomic location, frontal sinus fractures increased from 8% to 37%, zygomaticomaxillary fractures increased from 9% to 18%, nasoethmoid fractures decreased from 12% to 6%, orbital floor fractures decreased from 6% to 3%, and mandible fractures decreased from 28% to 18%. Single-site fractures increased from 75% to 90%. Length of intensive care unit and hospital stay remained stable at 3 and 7 days, respectively.
Despite a decrease in MVC-related facial fractures, the overall increase in facial fractures referred to our trauma center is due to a growing number of patient transfers from rural hospitals, where a paucity of qualified surgeons may exist.
Annals of plastic surgery 05/2012; 68(5):461-6. · 1.29 Impact Factor
ABSTRACT: To assess the impact of an independent call center on facilitation of burn and maxillofacial trauma patient transfer to a level 1 trauma center.
All patients admitted to our level 1 trauma center for definitive management of either burn or maxillofacial injuries from September 1, 2004 to September 1, 2008, 2 years before and after transfer service initiation on September 1, 2006, were identified using the North Carolina Trauma Registry. Cohort demographics, referral patterns, transfer times/distances, and clinical outcomes were assessed.
Burn patients increased from 1031 to 1208, from the 2 years before to after transfer center initiation. Average transport time increased from 113 to 165 minutes and average distance traveled increased from 84 to 86 miles. Out-of-state admissions increased from 24 to 46; number of referring counties increased from 58 to 60. Maxillofacial trauma patients increased from 390 to 576. Average transport time increased from 87 to 119 minutes, average distance increased from 84 to 89 miles, and number of referring counties jumped from 28 to 43. Length of stay did not change over the study period.
The initiation of an independent call center, designed to facilitate the transfer of patients with burn and maxillofacial injuries to a level 1 trauma center, increased the number of referrals and expanded our geographic footprint, but did not decrease transport times.
Annals of plastic surgery 05/2012; 68(5):484-8. · 1.29 Impact Factor