Table 5 Main remarks about the features in the system level, processes, and management practices in the study hospitals
From: International benchmarking of tertiary trauma centers: productivity and throughput approach
Level of analysis | Subject | UKB | HUS |
|---|---|---|---|
System-level features | Ownership & funding | Worker's foundation owned academic hospital, primarily for occupational injuries, but not exclusive 60% of patients occupationally insured, others with private or social insurance | Public-funded university hospital 100% of patient care funded by municipalities' income taxes |
Organization of care | All trauma patients (referred and non-referred) are taken care of | Primary trauma care is usually not taken care of; mostly, referred patients are seen | |
Catchment area | Primary: 260,000 Secondary: 3.3 M (competing for customers with 5 tertiary trauma centers); calculated average, 550,000 Tertiary: 7.7 M (competing for customers with 9 tertiary trauma centers); calculated average, 770,000 | Primary: 600,000 Secondary: 600,000 Tertiary: 1.5 M | |
Process and management features of trauma patients | Acute patient volumes | ED visits: 49,000 per year ⇒ ED admissions to hospital: 12,400 (25%) ⇒ Acute surgeries: 6,520 (for 4,660 patients) ⇒ Acute O&T surgeries: 2,280 (for 1,780 patients) | ED visits: 19,400 per year ⇒ ED admissions to hospital: 6,960 (36%) ⇒ Acute surgeries: 6,800 (for 5,140 patients) ⇒ Acute O&T surgeries: 3,550 (for 2,990 patients) |
Emergency department | All patients admitted to the ED. Rapid response and patient categorization highlighted in the reception Lean approach applied, especially in trauma team activations IT system supports rapid response and shift to the next phase of care | Non-severe primary traumas are directed to other hospitals Regional and national responsibility over care after catastrophes highlighted by the management Focus on maintaining capacity and readiness to receive multi-traumas and multiple patient scenarios in any circumstances | |
Pre-operative care | Patient transferred directly to an operating room or a ward unit Ward care conducted primarily in sub-specialty-focused ward units. High flexibility, however, between wards to accommodate patients from other sub-specialties | Most patients transferred to a dedicated ward unit for pre-operative trauma patients. Emergencies transferred directly to an operating room "Green line" is used a lot to discharge less severe trauma patients from the ED and to schedule a surgery in a defined operating room session within several days | |
Surgical care | Large multi-specialty operating unit. In addition, a couple of operating rooms for day surgeries Anesthesia induction conducted in a separate room in every surgery One anesthesiologist is responsible for one operating room | Dedicated operating units for O&T, neurosurgery, plastic and reconstructive surgery, and day surgery Anesthesia induction conducted in a separate room in a small part of surgeries One anesthesiologist is responsible for one to three operating rooms | |
Post-operative care | Conducted in the same ward as pre-operative care. Integrated rehabilitation care; almost all patients are discharged to home | Immediate post-operative care conducted in wards dedicated to certain injuries of different body parts Rehabilitation conducted mainly in communal hospitals |