Impact of Emergency Medicine Training Programs on Trauma Center Performance

Fewer complications
(5.1% vs. 11.0%) p < 0.0001

Lower mortality (4.7% vs. 5.4%) p = 0.0013

Shorter hospital Length Of Stay (4.9 days vs. 6.3 days) p < 0.0001

*Taylor et.al. J Emerg Med 2005

  • the specialty-based hospital care system is “diagnosis-based” and the population of acute patients seeking care are “symptom-based.” Bridging this gap is the key to high-performance acute care delivery. (Links to explanation)
  • A relatively small percent of all patients who present to the healthcare system with emergency complaints have a clear diagnosis which is obvious upon presentation (i.e. major trauma, stroke, ST elevation MI, etc.).
  • Most patients present to the health care system with undifferentiated complaints (i.e. chest pain, abdominal pain, fever, “I don’t feel well”, etc.).
  • The opportunity for both patients and the healthcare system is found in rapidly identifying, stabilizing and treating patients with true, time-sensitive emergencies as early as possible in the course of their disease, thus, in many cases, reducing the preventable morbidity, mortality and disability that would otherwise occur.
  • This also translates into downstream cost savings for the healthcare system and society in terms of shorter hospital lengths of stay, decreased utilization of healthcare and rehabilitation resources, and patients being able to return to work and family life sooner.
  • The challenge for the healthcare system is how to most quickly and efficiently evaluate and manage patients presenting to the healthcare system to identify those patients with true, time-sensitive emergencies.
  • The modern ED functions as the primary access portal to the hospital for all patients with acute problems.
  • The ED is staffed by specialist physicians and nurses with specific training, knowledge and skills for safely and effectively managing the large volumes of patients that present to the ED.  With this expertise, plus rapid access to necessary diagnostic and therapeutic resources, the ED is able to stabilize unstable patients, carry out appropriate diagnostic evaluations, initiate time sensitive treatments, determine which patients need to be admitted to hospital for definitive care, and discharge patients not requiring inpatient care for outpatient follow up in appropriate settings.
  • When the ED is staffed appropriately and operating at peak efficiency, numerous studies have shown significant benefits in terms of reduced morbidity and mortality, as well as reduced resource utilization at the hospital level (shorter lengths of stay, reduced use of specialists from multiple specialties in the ED, etc.).
Early Goal Directed Therapy in the Emergency Department for Sepsis Patients

Reduction in mortality from Early Goal Directed Therapy

Reduction in hospital length-of stay

Reduction in hospital costs related to sepsis

*Otero et.al. CHEST 2006