Invited Commentary <\/p>\n\n\n\n
Regionalization is a standard across many industries, with well-defined benefits in terms of resource aggregation, improved efficiency, and downstream cost savings. By concentrating expertise and experience, it also stands to reason that, for the care of the injured patient, the more a system, center, and individual clinician performs a task, the better the outcomes should be. Although there are data to support this at the system and trauma center level,1<\/a>-3<\/a><\/sup>\u00a0when individual clinician-level outcomes are examined, more patients have not been equated to better outcomes.4<\/a>,5<\/a><\/sup><\/p>\n\n\n\n In this study, Beiriger and colleagues6<\/a><\/sup> examined the patient volume to outcome association for prehospital clinicians using data from the Linking Investigations in Trauma and Emergency Services Task Order 1 study. They included moderate to severely injured patients, 91% blunt, with an Injury Severity Score of 9 or higher transported by 2 emergency medical services (EMS) agencies (75% by 1 air medical critical care agency and the remainder by 1 ground agency) to a single trauma center. In their primary analysis, evaluating the association between annual clinician trauma patient volume averaged over a 3-year period and mortality, the authors found a relative 10% decrease in 6-hour and 2.6% decrease in in-hospital mortality for each additional 5 trauma patient encounters for the primary treating prehospital clinician. This association held across multiple subgroups and appears to be more pronounced in more critically injured patients.<\/a><\/p>\n\n\n\n This outsize outcome benefit came down to only 5 additional patients. The clinicians in this study were, in general, highly experienced; 90% were employed for at least 3 years and had a median of 54 annual trauma patient encounters. What could not be explained by the authors, however, was what was gained in terms of expertise and technical proficiency, independent of their overall years of clinician experience, or a threshold minimum number of encounters, or even nontrauma patient volume, that resulted in this survival benefit. The only Ground and Air Medical Quality Transport (GAMUT) outcomes metric associated with prehospital clinician trauma patient volume was a reduction in scene time and the authors accounted for prehospital time in the primary model. Interestingly, this same survival benefit was not found in association with the maximum patient encounters among all treating clinicians. Although this makes sense when evaluating a particular skill such as intubation,7<\/a><\/sup> performed by an individual clinician, it is less clear when considering the complexities of managing a critically injured patient.<\/a><\/p>\n\n\n\n If these results are validated, what should EMS systems do to realize this benefit? Is the answer to disrupt contemporary scheduling practices to maximize the individual clinician experience? Is it to improve the clinician experience in lower volume agencies through simulated encounters, or does the answer lie in some unmeasured confounder? This study leaves many unanswered questions. What were the potentially preventable causes of death, and what were the prehospital life-saving interventions performed, or not, that impacted survival? The primary outcome measure was 6-hour mortality. A wide range of time-sensitive and potentially life-saving interventions likely occurred during the in-hospital phase of care, and understanding these important details will clarify the EMS clinicians\u2019 contribution to the reduced mortality.<\/a><\/p>\n\n\n\n We applaud the authors for addressing this important topic. Although adjusting staffing models to optimize clinician experience is appealing, in reality, it is complex to operationalize within EMS systems that are already struggling to maintain adequate staffing and retain experienced clinicians. Requirements for additional training also come at a cost. These conclusions are, indeed, noteworthy but must be validated before trauma systems consider implementation of volume-based requirements for prehospital clinicians.<\/p>\n","protected":false},"excerpt":{"rendered":" Invited Commentary Trauma Patient Volume and Clin […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30292"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=30292"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30292\/revisions"}],"predecessor-version":[{"id":30293,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30292\/revisions\/30293"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30292"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30292"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30292"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}