How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study

Arturo Chieregato, Annalisa Volpi, Giovanni Gordini, Chiara Ventura, Marco Barozzi, Maria Luisa Rita Caspani, Andrea Fabbri, Anna Maria Ferrari, Enrico Ferri, Aimone Giugni, Massimiliano Marino, Costanza Martino, Mario Pizzamiglio, Maurizio Ravaldini, Emanuele Russo, Laura Trabucco, Susanna Trombetti, Rossana De Palma

Research output: Contribution to journalArticle

Abstract

Objective To evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system. Setting ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million. Participants 5300 patients with an Injury Severity Score (ISS) >15 were admitted to the regional ICUs and recorded in the Regional Severe Trauma Registry between 2007 and 2012. Patients were classified by the Abbreviated Injury Score as follows: (1) traumatic brain injury (2) multiple injuriesand (3) extracranial lesions. The SIATs were divided into those with at least one neurosurgical level II trauma centre (TC) and those with a neurosurgical unit in the level I TC only. Results A higher proportion of patients (out of all SIAT patients) were admitted to the level I TC at the head of the SIAT with no additional neurosurgical facilities (1083/1472, 73.6%) compared with the level I TCs heading SIATs with neurosurgical level II TCs (1905/3815; 49.9%). A similar percentage of patients were admitted to level I TCs (1905/3815; 49.9%) and neurosurgical level II TCs (1702/3815, 44.6%) in the SIATs with neurosurgical level II TCs. Observed versus expected mortality (OE) was not statistically different among the three types of centre with a neurosurgical unit; however, the best mean OE values were observed in the level I TC in the SIAT with no neurosurgical unit. Conclusion The Hub and Spoke concept was fully applied in the SIAT in which neurosurgical facilities were available in the level I TC only. The performance of this system suggests that competition among level I and level II TCs in the same Trauma System reduces performance in both. The density of neurosurgical centres must be considered by public health system governors before implementing trauma systems.

Original languageEnglish
Article numbere016415
JournalBMJ Open
Volume7
Issue number9
DOIs
Publication statusPublished - Sep 1 2017

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Trauma Centers
Italy
Health Services
Intensive Care Units
Cross-Sectional Studies
Wounds and Injuries
Injury Severity Score
Mortality
Registries
Patient Care
Public Health
Head
Population

Keywords

  • clinical governance
  • neurosurgery
  • quality In health care
  • Trauma management

ASJC Scopus subject areas

  • Medicine(all)

Cite this

How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study. / Chieregato, Arturo; Volpi, Annalisa; Gordini, Giovanni; Ventura, Chiara; Barozzi, Marco; Caspani, Maria Luisa Rita; Fabbri, Andrea; Ferrari, Anna Maria; Ferri, Enrico; Giugni, Aimone; Marino, Massimiliano; Martino, Costanza; Pizzamiglio, Mario; Ravaldini, Maurizio; Russo, Emanuele; Trabucco, Laura; Trombetti, Susanna; De Palma, Rossana.

In: BMJ Open, Vol. 7, No. 9, e016415, 01.09.2017.

Research output: Contribution to journalArticle

Chieregato, A, Volpi, A, Gordini, G, Ventura, C, Barozzi, M, Caspani, MLR, Fabbri, A, Ferrari, AM, Ferri, E, Giugni, A, Marino, M, Martino, C, Pizzamiglio, M, Ravaldini, M, Russo, E, Trabucco, L, Trombetti, S & De Palma, R 2017, 'How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study', BMJ Open, vol. 7, no. 9, e016415. https://doi.org/10.1136/bmjopen-2017-016415
Chieregato, Arturo ; Volpi, Annalisa ; Gordini, Giovanni ; Ventura, Chiara ; Barozzi, Marco ; Caspani, Maria Luisa Rita ; Fabbri, Andrea ; Ferrari, Anna Maria ; Ferri, Enrico ; Giugni, Aimone ; Marino, Massimiliano ; Martino, Costanza ; Pizzamiglio, Mario ; Ravaldini, Maurizio ; Russo, Emanuele ; Trabucco, Laura ; Trombetti, Susanna ; De Palma, Rossana. / How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study. In: BMJ Open. 2017 ; Vol. 7, No. 9.
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abstract = "Objective To evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system. Setting ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million. Participants 5300 patients with an Injury Severity Score (ISS) >15 were admitted to the regional ICUs and recorded in the Regional Severe Trauma Registry between 2007 and 2012. Patients were classified by the Abbreviated Injury Score as follows: (1) traumatic brain injury (2) multiple injuriesand (3) extracranial lesions. The SIATs were divided into those with at least one neurosurgical level II trauma centre (TC) and those with a neurosurgical unit in the level I TC only. Results A higher proportion of patients (out of all SIAT patients) were admitted to the level I TC at the head of the SIAT with no additional neurosurgical facilities (1083/1472, 73.6{\%}) compared with the level I TCs heading SIATs with neurosurgical level II TCs (1905/3815; 49.9{\%}). A similar percentage of patients were admitted to level I TCs (1905/3815; 49.9{\%}) and neurosurgical level II TCs (1702/3815, 44.6{\%}) in the SIATs with neurosurgical level II TCs. Observed versus expected mortality (OE) was not statistically different among the three types of centre with a neurosurgical unit; however, the best mean OE values were observed in the level I TC in the SIAT with no neurosurgical unit. Conclusion The Hub and Spoke concept was fully applied in the SIAT in which neurosurgical facilities were available in the level I TC only. The performance of this system suggests that competition among level I and level II TCs in the same Trauma System reduces performance in both. The density of neurosurgical centres must be considered by public health system governors before implementing trauma systems.",
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AU - Chieregato, Arturo

AU - Volpi, Annalisa

AU - Gordini, Giovanni

AU - Ventura, Chiara

AU - Barozzi, Marco

AU - Caspani, Maria Luisa Rita

AU - Fabbri, Andrea

AU - Ferrari, Anna Maria

AU - Ferri, Enrico

AU - Giugni, Aimone

AU - Marino, Massimiliano

AU - Martino, Costanza

AU - Pizzamiglio, Mario

AU - Ravaldini, Maurizio

AU - Russo, Emanuele

AU - Trabucco, Laura

AU - Trombetti, Susanna

AU - De Palma, Rossana

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N2 - Objective To evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system. Setting ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million. Participants 5300 patients with an Injury Severity Score (ISS) >15 were admitted to the regional ICUs and recorded in the Regional Severe Trauma Registry between 2007 and 2012. Patients were classified by the Abbreviated Injury Score as follows: (1) traumatic brain injury (2) multiple injuriesand (3) extracranial lesions. The SIATs were divided into those with at least one neurosurgical level II trauma centre (TC) and those with a neurosurgical unit in the level I TC only. Results A higher proportion of patients (out of all SIAT patients) were admitted to the level I TC at the head of the SIAT with no additional neurosurgical facilities (1083/1472, 73.6%) compared with the level I TCs heading SIATs with neurosurgical level II TCs (1905/3815; 49.9%). A similar percentage of patients were admitted to level I TCs (1905/3815; 49.9%) and neurosurgical level II TCs (1702/3815, 44.6%) in the SIATs with neurosurgical level II TCs. Observed versus expected mortality (OE) was not statistically different among the three types of centre with a neurosurgical unit; however, the best mean OE values were observed in the level I TC in the SIAT with no neurosurgical unit. Conclusion The Hub and Spoke concept was fully applied in the SIAT in which neurosurgical facilities were available in the level I TC only. The performance of this system suggests that competition among level I and level II TCs in the same Trauma System reduces performance in both. The density of neurosurgical centres must be considered by public health system governors before implementing trauma systems.

AB - Objective To evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system. Setting ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million. Participants 5300 patients with an Injury Severity Score (ISS) >15 were admitted to the regional ICUs and recorded in the Regional Severe Trauma Registry between 2007 and 2012. Patients were classified by the Abbreviated Injury Score as follows: (1) traumatic brain injury (2) multiple injuriesand (3) extracranial lesions. The SIATs were divided into those with at least one neurosurgical level II trauma centre (TC) and those with a neurosurgical unit in the level I TC only. Results A higher proportion of patients (out of all SIAT patients) were admitted to the level I TC at the head of the SIAT with no additional neurosurgical facilities (1083/1472, 73.6%) compared with the level I TCs heading SIATs with neurosurgical level II TCs (1905/3815; 49.9%). A similar percentage of patients were admitted to level I TCs (1905/3815; 49.9%) and neurosurgical level II TCs (1702/3815, 44.6%) in the SIATs with neurosurgical level II TCs. Observed versus expected mortality (OE) was not statistically different among the three types of centre with a neurosurgical unit; however, the best mean OE values were observed in the level I TC in the SIAT with no neurosurgical unit. Conclusion The Hub and Spoke concept was fully applied in the SIAT in which neurosurgical facilities were available in the level I TC only. The performance of this system suggests that competition among level I and level II TCs in the same Trauma System reduces performance in both. The density of neurosurgical centres must be considered by public health system governors before implementing trauma systems.

KW - clinical governance

KW - neurosurgery

KW - quality In health care

KW - Trauma management

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