Impact of Trauma Team Census on Patients With Rib Fractures

TL;DR

This study finds that high trauma team workloads are linked to fewer ICU admissions and more delirium in rib fracture patients.

Contribution

The study evaluates how trauma team workload affects patient outcomes, revealing under-triage risks during high census periods.

Findings

High census admissions had lower ICU admission rates (OR: 0.78, p=0.034).

High census admissions had higher delirium risk (OR: 3.21, p=0.005).

Demographics and comorbidities were similar between high and low census groups.

Abstract

Background: Workloads of healthcare professionals have continued to increase in recent years. With increased workload, some studies have shown increased length of stay for patients, higher cost, and higher risk of patient safety events. Trauma teams are a group that is particularly vulnerable to changes in patient census. This study aims to evaluate the impact of high versus low trauma team census on outcomes.

Methods: A retrospective review of all rib fracture patients at a level I trauma center from 2017 to 2022 was conducted. The average daily census was determined, and high or low census days were assessed by being above or below this, respectively. The impact of census levels on outcomes was assessed using bivariate analysis and multivariate regression.

Results: A total of 1,291 patients were included, with 663 admitted on high census days and 628 admitted on low census days. Demographics and comorbidities were similar between groups. Surgical fixation rates and time to surgery were similar between census levels. High census admissions had lower ICU admission rates (odds ratio (OR): 0.78, p=0.034) and higher delirium risk (OR: 3.21, p=0.005).

Conclusion: Despite some seasonal variation between groups, patients admitted on high and low census days have similar demographics and prehospital comorbidities. However, patients admitted on high census days were less likely to receive ICU admission and had increased delirium rates, raising concerns about under-triage and emphasizing the need for improved resource allocation during high-volume periods.