ideal ER lengths of stay?

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Caesar,

I am not sure what the correct answer is.  However, I am fairly certain that we are going to see a push towards regionalization of trauma care.  This is being driven by the paucity of subspecialty surgeons who continue to take call WITHOUT being paid (predominantly neurosurgeons and ortho surgeons) and that will indeed force many Level III and SOME Level II's and I's out of the business of caring for trauma patients! 

True, true and unrelated, you will say, and I agree.  That was a long jump for the short walk to the answer to your question.  Yes I do believe that if you cannot take a patient directly to the OR when that patient needs an operation, then you have no business being a trauma center.  The argument that one would make now is that "The patient is going to die if we don't get him/her somewhere to be stabilized and shipped.  My argument would be that the patient that has to go somewhere where time and resources are expended so that the patient can be "stabilized" and the patient then gets somewhere else for definitive OPERATIVE therapy is going to DIE the majority of the time.

SO, now tell me please what your definition of a Level III Trauma Center is.  Or a Level II or Level I Trauma Center?  Are you talking about the ACS COT VERIFIED Trauma Centers?  I am wondering.......  The "Green Book" states, "For level III trauma centers, it is expected that the surgeon will be in the emergency department on patient arrival, with adequate notification from the field.  The maximum acceptable response time is 30 minutes, tracked from patient arrival."   And the requirement for Level II trauma centers is that notorious "15 minute rule".  As I see it, the implication of this is that the OR in that hospital can be up and running within 30 minutes, and the surgeon will be able to take the patient to the OR for that splenectomy or damage control surgery in 35 minutes.  How many Level III trauma centers that exist today actually fit this criteria?  And how about that epidural that needs to go to the OR PDQ (pretty damn quick)?  Should the severe head injury stop at the Level III just long enough to herniate?

In short (Thank God!!, you are saying by now) I do not know what the correct answer is.  I do know that I believe that the actual answer to your question is going to be "Yes, I know"!

Best wishes,
Ron

>>> "caesar ursic" <cmursic at gmail.com> 10/12/2007 5:07 PM >>>
So let me get this straight, Ron:  Unless my hospital sees a high enough
volume of critically-injured patients to justify the expense of maintaining
an trauma-dedicated OR (always on stand-by, always available) with the
concommitant personel also alwyas on stand-by (nurses, techs,
anesthesiologists), then my hospital shouldn't be seing trauma patients?
Really?  Do you realize that you've just eliminated most, if not all, level
III trauma centers (and many level II trauma centers) in this country?

C. Ursic
Santa Fe
USA


On 10/12/07, Ronald Gross <Rgross at harthosp.org> wrote:
>
> Not if your OR has a dedicated room for trauma, and a staff that deals
> with these cases every day.  And if you don't, then the patient shouldn't be
> in your ED, unless you are the only place within a couple of hundred miles.
>
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