Falls, self-pay data are key stats in ACS report

Examine length of stay by injury

ED managers should note two areas of the recently released 2004 Annual Report from the National Trauma Data Bank (NTDB) of the American College of Surgeons (ACS): the aging population and falls, and the number of self-pay payments.

That’s the advice of Connie J. Potter, RN, MBA:HCA, executive director of the Irvine, CA-based National Foundation for Trauma Care and a former Level I ED and trauma administrator. Falls, she notes, account for 16.7% of cases reported to the NTDB, with the incidence of falls peaking for people at 82 years of age.

Geriatric falls: On the bed "like velcro"

"The incidence of falls is growing, and the geriatric population who suffers trauma very rarely return to home, and within one year the vast majority are dead," she says. "The disposition of these patients presents the ED with a particular problem that translates into ED overload and diversion; once that person’s on the bed [he or she is] there like Velcro." It is this inability to get these patients to subacute care that leads to ED crowding, which in turn, leads to diversions, Potter explains.

The number of self-pay patients is significant, she continues, "because trauma patients are disproportionately self-pay," Potter says. Self-pay is the largest single payment category (20.59%) in the databank, followed by managed care (14.3%), and Medicare (13.48%).

"About one-fourth of them make over $60,000, and many are self-employed people who choose to go without insurance because they are risk-takers — or they’re young and don’t think they need it," she notes.

This translates into a huge problem for higher-level trauma centers, Potter says. "It results in longer transport time for ambulances," due to diversion she observes. "Patients come to you in worse shape, and the ED can’t bill and collect for these folks."

The NTDB report contains a wealth of information based on more than 1.1 million records from 405 trauma centers in 43 states, territories, and the District of Columbia — the largest aggregation of trauma registry data that has ever been assembled, according to the ACS.

Data includes LOS

In addition to providing information about what types of traumatic injuries result in the most fatalities, the report also examines traumatic injury variations by age and gender, as well as hospital length of stay related to the mechanism of injury and source-of-payment issues. The ACS is now using NTDB data to work with the Health Resources and Services Administration (HRSA) on a project to develop a national minimum trauma care data set. In addition, the two groups are developing a national sample that will allow trauma researchers to make inferences about a trauma population when using NTDB data for analyses.

The entire National Trauma Data Bank Report Version 4.0 is available free on the ACS web site at www.ntdb.org. On the right side of the page, click on "National Trauma Data Bank Report 2004 (4700K PDF)" or "National Trauma Data Bank Report 2004 (5100K PowerPoint)."

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