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Tue Jun 8 21:07:47 BST 2010

Karim,

Yes you're right the ED wait times was even mentioned in the abstract. Which is actually a huge issue.

Rob

On Jun 8, 2010, at 11:59 AM, Karim Brohi wrote:

> Robert
> If you read the paper it talks about improving ED wait times and other
> general improvements in resource utilization.
> Karim
> 
> On 8 June 2010 14:53, Robert Smith <rfsmithmd at comcast.net> wrote:
> 
>> Caesar,
>> 
>> What a fascinating question. I wonder how it would be approached in any
>> sort of scientific manner. Being a believer in trauma centers and the
>> process that good ones bring to bear, I would like to think there is a
>> positive carryover but how to investigate that??
>> 
>> Personally, I would contact Ellen Mackenzie at Johns Hopkins School of
>> Public Health:  http://faculty.jhsph.edu/default.cfm?faculty_id=439
>> and also Greg Bishop of Bishop and Associates:
>> http://www.traumacare.com/bios/bishop.php
>> 
>> Karim, at least from the abstract, this looks like an examination of the
>> performance of the trauma program rather than the change in performance of
>> the hospital as a whole. Several of the other articles by Eddie Cornwell
>> also looked at factors which may have influenced program performance and/or
>> outcomes.
>> 
>> Pret is right that in the initial development of trauma systems, the "Halo
>> Effect" was a perceived effect that general patients would be drawn to the
>> more powerful and highly functioning trauma centers. This belief was a
>> barrier to system development as it was used by hospital associations to
>> invoke the fear that participation in a regionalized trauma system would
>> unfairly punish the majority of hospitals which would not become trauma
>> centers, yet which might be excellent facilities in their own right. And he
>> is correct that often before the first round of re-designation, the glow of
>> being a trauma center had begun to wear off. In fact some urban specialty
>> centers (read Pediatric ) which SHOULD have been trauma centers began to get
>> seriously cold feet for the reasons Pret mentioned.
>> 
>> I don't know how "easy" it was in urban areas to achieve trauma center
>> designation. By 1976 the ACS had published the first version of Optimal
>> Hospital Resources for Care of the Injured Patient and I think most
>> designation standards would have born a strong resemblance to this
>> benchmark. With all of the politics of money and  government and healthcare
>> organizations and within the hospitals themselves...... it was certainly a
>> struggle in Chicago to achieve a system. And it remains an ongoing struggle.
>> One in which I think the state is currently failing. But that's also a
>> different question.
>> 
>> Rob Smith
>> 
>> 
>> On Jun 7, 2010, at 3:57 PM, caesar ursic wrote:
>> 
>>> Hoping y'all can help me out here...
>>> 
>>> I recall at least one-two papers published within last ten years or so
>> that
>>> demonstrated that there were "surprise" benefits to the hospital as a
>> whole
>>> from pursuing and acquiring verification as a trauma center.  In other
>>> words, once the hospital went through the process and began functioning
>> as a
>>> verified trauma center, there were quality of care improvements in other
>>> areas (i.e. cardiology, CV surgery, gen surgery, etc).
>>> 
>>> Any recollection?  PubMed has not helped me....
>>> 
>>> Thanks,
>>> C. Ursic, MD
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