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Length of stay as an indicator for efficient and effective trauma management pre and post implementation of a State Major Trauma Unit in Western Australia.

Hiller, Krystle (2009) Length of stay as an indicator for efficient and effective trauma management pre and post implementation of a State Major Trauma Unit in Western Australia. Honours thesis, Murdoch University.

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Background: Trauma is the leading cause of death of Australians aged between 14 and 50 years with trauma admissions to hospitals costing governments millions of dollars per year. Managing health budgets set by governments whilst still delivering quality health care is an important issue. Strategies for addressing effectiveness and efficiency are often focused on providing high quality, cost effective services, which are aimed at reducing hospital length of stay while providing appropriate care. One such strategy adopted by Royal Perth Hospital (RPH) has been the creation of a new State Major Trauma Unit (SMTU) that offers increased trauma services by allowing for greater contact between patients, nursing medical and allied health teams.

Aim: The aim of this study was to evaluate the new Western Australian State Major Trauma Unit and its impact on length of hospital stay in major trauma patients. Results can be used to analyse one indicator of effectiveness; namely, length of stay in relation to differing types of services offered pre and post impementation of the SMTU. This provides the basis for recommendations for further studies into effectiveness and efficiency in trauma management in areas such as cost analysis, delayed discharges and unplanned admissions.

Methodology: A retrospective analysis was conducted using data from the Trauma Registry from Royal Perth Hospital. Data on the length of stay (LOS) of patients with an Injury Severity Score (ISS) >15 who were admitted to any general ward at RPH in 2007, prior to establishment of the SMTU, were compared with data from patients who were admitted to the SMTU during the same period in 2008. Descriptive analysis included comparisons of median and interquartile range of age, sex, admission, specialty, discharge destination and ISS. A Chi Square Test of Contingencies or Mann Whitney U test was used to test for any differences in demographic data and the length of stay between these two groups. All p values < .05 are considered significant.

Results: There was no statistically significant difference found between the length of stay or Injury Severity Score of major trauma patients who were admitted to RPH in 2007 and 2008.

Conclusions: The results are useful in providing an indicator of trauma patient management in terms of length of stay. The lack of a significant finding suggests the need for a longer term analysis of the LOS for patients admitted to the SMTU and further research into other indicators of effectiveness and efficiency.

Item Type: Thesis (Honours)
Murdoch Affiliation(s): School of Nursing & Midwifery
Supervisor(s): McMurray, Anne and Fetherston, Catherine
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