Models of care for traumatically injured patients at trauma centres in British Columbia: Variability and sustainability

Abstract

Background Successful trauma systems employ a network of variably-resourced hospitals, staffed by experienced providers, to deliver optimal care for injured patients. The model of care - the manner by which inpatients are admitted and overseen, is an important determinant of patient outcomes. Objectives To describe the models of inpatient trauma care at British Columbia's (BC's) ten adult trauma centres, their sustainability, and their compatibility with accreditation guidelines. Methods Questionnaires were distributed to the trauma medical directors at BC's ten Level I-III adult trauma centres. Follow-up semi-structured interviews clarified responses. Results Three different models of inpatient trauma care exist within BC. The admitting trauma service was a multidisciplinary team providing exclusive care for injured patients. The on-call consultant assisted with Emergency Department (ED) resuscitation before transferring patients to a non-trauma admitting service. The single short-stay trauma unit employed on-call consultants who also oversaw a 48-hour short-stay ward. Both level I trauma centres utilized the admitting trauma service model (2/2). All Level II sites employed an on-call consultant model (3/3), deviating from Level II trauma centre accreditation standards. Level III sites employed all three models in similar proportions. None of the on-call consultant sites believed their current care model was sustainable. Inadequate compensation, insufficient resources, and difficulty recruiting physicians were cited barriers to sustainability and accreditation compliance. Conclusions Three distinct models of care are distributed inconsistently across BC's Level I-III trauma hospitals. Greater use of admitting trauma service and short-stay trauma unit models may improve the sustainability and accreditation compliance of our trauma system.