Models of care for traumatically injured patients at trauma centres in British Columbia: variability and sustainability.

BACKGROUND: Successful trauma systems employ a network of variably-resourced hospitals, staffed by experienced providers, to deliver optimal care for injured patients. The "model of care"-the manner by which inpatients are admitted and overseen, is an important determinant of patient outcomes.

OBJECTIVES: To describe the models of inpatient trauma care at British Columbia's (BC's) ten adult trauma centres, their sustainability, and their compatibility with accreditation guidelines.

METHODS: Questionnaires were distributed to the trauma medical directors at BC's ten Level I-III adult trauma centres. Follow-up semi-structured interviews clarified responses.

RESULTS: Three different models of inpatient trauma care exist within BC. The "admitting trauma service" was a multidisciplinary team providing exclusive care for injured patients. The "on-call consultant" assisted with Emergency Department (ED) resuscitation before transferring patients to a non-trauma admitting service. The single "short-stay trauma unit" employed on-call consultants who also oversaw a 48-hour short-stay ward. Both level I trauma centres utilized the admitting trauma service model (2/2). All Level II sites employed an on-call consultant model (3/3), deviating from Level II trauma centre accreditation standards. Level III sites employed all three models in similar proportions. None of the on-call consultant sites believed their current care model was sustainable. Inadequate compensation, insufficient resources, and difficulty recruiting physicians were cited barriers to sustainability and accreditation compliance.

CONCLUSIONS: Three distinct models of care are distributed inconsistently across BC's Level I-III trauma hospitals. Greater use of admitting trauma service and short-stay trauma unit models may improve the sustainability and accreditation compliance of our trauma system.