Effect of Resident Involvement on Trauma Patient Outcomes: A Single-Institution Review

Elsevier

Available online 23 October 2022

Journal of Surgical EducationOBJECTIVE

The purpose of this study was to examine the mortality difference and other outcome measures amongst trauma patients with residents involved in the initial management versus those that were managed by attending physicians only without resident involvement.

DESIGN

Retrospective review. Chi-square, Fisher's tests were used to analyze the outcomes, diagnostics, and interventions using the presence of residents in the initial care of patients as an independent variable. Linear and logistic regression were used to estimate adjusted outcomes.

SETTING

Riverside Community Hospital, Riverside California (State-designated level I trauma center)

PARTICIPANTS

Data on all trauma patients ≥18 years old that were admitted between July 1, 2018 and June 30, 2020 was collected retrospectively (total 2644 trauma patients). Trauma patients that were transferred from outside facilities were excluded from the study.

RESULTS

There was no significant difference in mortality associated with resident involvement in both unadjusted and adjusted analysis. Patients treated by residents, however, had more comorbidities (higher CCI) and were more severely injured (higher ISS). On adjusted analysis, higher ISS was independently associated with resident presence. There was also a statistically significant increase in the use of diagnostic studies and therapeutic interventions in the resident-present group.

CONCLUSIONS

Involvement of residents in the initial management of our trauma patient population was associated with no difference in overall mortality or morbidity, despite higher injury severity in the resident treated patient group.

Section snippetsINTRODUCTION

Residents have been associated with increasing morbidity and mortality, prolonging hospital and intensive care unit (ICU) stays and increasing cost in trauma care.1, 2, 3 The well documented “July phenomenon” demonstrates increased risk of medical errors and surgical complications at the start of residency training.1,4 In the literature, studies show conflicting trauma patient outcomes due to resident involvement.2,3,5, 6, 7, 8

Taylor et al. showed that the presence of an emergency medicine

Setting and Participants

This retrospective study was conducted at a state designated level I trauma center. After starting an emergency medicine residency program in 2017, residents started participating in trauma resuscitations under faculty supervision. Records of all adult (≥18 years old) trauma patients admitted beginning one year after the establishment of the residency program between July 1, 2018 and June 30, 2020 were then reviewed. Patients transferred in from outside hospitals were excluded as their initial

RESULTS

A total of 2644 adult trauma patients were admitted to our institution from July 1, 2018 to June 30, 2020. 1614 patients had a RP in the initial management, and 1030 did not. Demographic data are detailed in Table 1. There was no significant difference in mortality after univariate analysis. There was a statistically significantly increase in ISS and CCI in the RP group versus NP group.

Select intervention variables are described in Table 2. p-values presented are following logistic regression

DISCUSSION

This study compared interventions and outcomes between trauma patients that had residents involved in their initial resuscitation versus those that did not. Residents were involved with more critically ill (higher CCI) and more critically injured (higher ISS) patients. There was no difference in mortality based on resident involvement on univariate analysis or after adjusting for demographic, diagnostic, and therapeutic intervention differences. Thus, the similar mortality rates seen between

CONCLUSION

This study supports a growing body of literature showing unaffected or improved trauma patient outcomes with resident involvement. Our study demonstrated no change in mortality or morbidity whether or not residents were present in the initial trauma resuscitation.

Declaration of Competing Interest

None.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgments

None.

References (10)

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© 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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