Staff commitment to trauma care improves mortality and length of stay at a level I trauma center.

Background: Optimizing human resources at trauma facilities may increase quality of care. The purpose of this study was to assess whether staffing changes within a Level I trauma center improved mortality and shortened length of stay (LOS) for trauma patients. Methods: Mortality, hospital LOS, and intensive care unit LOS were evaluated during three time periods: trauma service coverage by in-house general surgery residents and attendings ("group 1"), the creation of a core trauma panel with in-house trauma surgeons ("group 2"), and the addition of physician assistants (PAs) to the core trauma panel ("group 3"). Logistic regression and χ 2 tests were used to compare mortalities, and multiple linear regression, t-tests, and median tests were used to compare LOS. Results: There were 15,297 adult patients with trauma included in the analysis. After adjustment for transfers-in, mechanism of injury, injury severity score, age, and head injury, the presence of in-house trauma surgeons (group 2) decreased the following compared with group 1: overall mortality (3.12% vs. 3.82 %, p = 0.05), mortality in the severely injured (11.41% vs. 14.83%, p = 0.02), and median intensive care unit LOS (3.03 days vs. 3.40 days, p = 0.006). The introduction of PAs to the core trauma panel (group 3 vs. group 2) decreased overall mortality (2.80% vs. 3.76%, p = 0.05), and reduced mean and median hospital LOS (4.32 days vs. 4.69 days, p = 0.05; and 3.74 days vs. 3.88 days, p = 0.02, respectively). Conclusion: The presence of in-house core trauma surgeons and PAs improves management and outcome of critically injured trauma patients within a level I trauma center.