Professionalism of Admitting and Consulting Services and Trauma Patient Outcomes
William O. Cooper, Gerald B. Hickson, Oscar D. Guillamondegui, Jeremy W. Cannon, Anthony Charles, J. Jason Hoth, Hasan B. Alam, Areti Tillou, Fred A. Luchette, Dionne A. Skeete, Henry J. Domenico, J. Wayne Meredith, Theresa Brennan, Brian P. Smith, Rachel R. Kelz, Ben E. Biesterveld, Ashley Busuttil, Jeffrey K. Jopling, Joseph Hopkins, Cynthia L. Emory, Patricia Sullivan, RichardB. Martin, Russell Howerton, Henry M. Cryer, Heather Davidson, Richard P. Gonzalez, David A. Spain
Abstract
OBJECTIVE: To determine whether trauma patients managed by an admitting or consulting service with a high proportion of physicians exhibiting patterns of unprofessional behaviors are at greater risk of complications or death. SUMMARY BACKGROUND DATA: Trauma care requires high-functioning interdisciplinary teams where professionalism, particularly modeling respect and communicating effectively, is essential. METHODS: This retrospective cohort study used data from 9 level I trauma centers that participated in a national trauma registry linked with data from a national database of unsolicited patient complaints. The cohort included trauma patients admitted January 1, 2012 through December 31, 2017. The exposure of interest was care by 1 or more high-risk services, defined as teams with a greater proportion of physicians with high numbers of patient complaints. The study outcome was death or complications within 30 days. RESULTS: Among the 71,046 patients in the cohort, 9553 (13.4%) experienced the primary outcome of complications or death, including 1875 of 16,107 patients (11.6%) with 0 high-risk services, 3788 of 28,085 patients (13.5%) with 1 high-risk service, and 3890 of 26,854 patients (14.5%) with 2+ highrisk services (P < 0.001). In logistic regression models adjusting for relevant patient, injury, and site characteristics, patients who received care from 1 or more high-risk services were at 24.1% (95% confidence interval 17.2% to 31.3%; P < 0.001) greater risk of experiencing the primary study outcome. CONCLUSIONS: Trauma patients who received care from at least 1 service with a high proportion of physicians modeling unprofessional behavior were at an increased risk of death or complications.