Martin CL, Aldridge PJ, Harris AM, Perkins CH. J. Orthop. Trauma 2016; 30(10): 517-523.
Affiliation
1Resident Physician University of Florida College of Medicine Jacksonville Department of Orthopaedic Surgery 2Biostatistician University of Florida College of Medicine Jacksonville Center for Health Equity and Quality Research 3Assistant Professor University of Florida College of Medicine Jacksonville Department of Orthopaedic Surgery 4Assistant Professor Baylor College of Medicine Department of Orthopedic Surgery.
OBJECTIVES: To describe how the initiation and later removal of a provisional level II trauma center (PL2TC) status at a community hospital affected the volume and severity of injured patients seen at an established academic level 1 trauma center (AL1TC).
METHODS: Census data including counts of injury ICD-9 codes and patients seen in the emergency department and trauma center at an AL1TC were collected monthly from January 2010-October 2014. An interrupted time series analysis was used to model the monthly census data with two time interruptions in order to describe the change in patient volume at the interruptions. The interruptions were 1) the initiation of the PL2TC status at a nearby community hospital and 2) the subsequent removal of the PL2TC status.
RESULTS: The number of diagnoses, encounters and patients seen at the AL1TC emergency department decreased while the PL2TC was operating. After the removal of the PL2TC status, there was a 19.4% increase in emergency department patient volume per month at the AL1TC. The number of orthopaedic trauma patients seen through the emergency department at the AL1TC dropped 11.1% per month when the PL2TC began functioning as a trauma center. However, the volume of orthopaedic patients at the AL1TC did not recuperate after the PL2TC lost level 2 status.
CONCLUSIONS: A significant decrease in patient volume was seen at the AL1TC with the initiation of the PL2TC in close proximity. Orthopaedic patient volume did not recuperate after the removal of the PL2TC status.