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Level-I orthopaedic trauma care: a model for longevity.

Affiliation with a level-I trauma center imposes a heavy burden on any orthopaedic practice. This burden is manifested in the required trauma call; the issues centered on providing appropriate, timely care for trauma patients; and, finally, in the financial disincentive to providing trauma care1,2. These issues are expanded in terms of the required commitments to achieve success, including institutional support, support from the academic department chairman, and dedication from all members of the orthopaedic practice2-5. Although certainly not unique, the system developed at our medical center has demonstrated efficient, high-level care for patients with musculoskeletal injury. It has improved our ability to generate revenue for the department, and it has prevented “burnout” or turnover of the musculoskeletal traumatologists. We describe this model as an example of a system that has worked well in a level-I academic trauma center.

Elaboration on the difficulties associated with level-I trauma care is required to fully appreciate the success of our program. Required trauma call places considerable demands on individual orthopaedic surgeons. Trauma and injury occur throughout the day with no respect for work, family, or sleep schedules. Often the injuries require immediate evaluation and prompt surgical intervention. In light of a busy practice, the disruption caused by the need to provide immediate trauma care can result in the cancellation of elective surgeries or office visits. It can further disrupt already compromised family time. Off-hours care may drain the physician for the next day, as well as potentially compromise the outcome for the patient6,7. Finally, patients with nonemergent conditions who move to the “add-on” schedule the following day further extend the time commitment for trauma call and the frustration related to trauma care.

To expand on these issues, the effect of trauma care …