MSS864: I'LL PAY YOU TODAY FOR A TRAUMA PATIENT TOMORROW: THE HUMAN COST OF BUILDING A TRAUMA PROGRAM
Christopher Dyke; Walter Reed National Military Medical Center
Objectives: There is a push from local and national leadership to make Military Treatment Facilities (MTFs) designated trauma centers. One requirement, for the most critically injured patients, is availability of a surgeon at bedside within 15 minutes. One MTF seeking accreditation mandated in-house overnight call for all general surgeons with no expectation that surgeons work 24 or more consecutive hours. We examine how instituting in house call potentially affected surgeons that have a primarily elective surgical practice and patient access to care.
Methods: Clinic, operating room, and call schedules were retrospectively reviewed for the third quarter of 2025. Surgeons seeing at least two days a week of elective general surgery clinic were identified. The number of clinic and OR patients seen the day of and day after a call shift were recorded, and those seen after the surgeon spent more than 24 hours in the hospital were recorded. Number of priority trauma patients, trauma resuscitations, and operative trauma cases were also recorded. Surgeons were queried for reasons why they worked 24 or more consecutive hours.
Results: Five surgeons were identified as having a primarily elective surgical practice and participating in overnight trauma call. A total of 116 patients were seen on the day of a call shift, and 55 patients were seen following a call shift. 8 procedures were performed on the day of a call shift, and 23 procedures were performed following a call shift. After a period of more than 24 hours in the hospital 32 patients were evaluated in clinic and 14 operations were performed. Cases performed ranged from exams under anesthesia to gastric bypasses and cancer surgeries. These surgeons saw zero priority trauma activations and performed zero operations for trauma. Reasons cited for working more than 24 hours included avoiding patient cancelations and concerns over losing OR time.
Conclusions: While trauma experience is important for all military surgeons, mandatory, in-house, overnight call creates the potential for limiting access to care and increasing wait times for elective surgery patients and decreasing operative experience for surgeons if elective practices modified schedules to avoid working 24 or more consecutive hours (171 patients and 31 operations). Surgeons feel pressure to work longer than 24 hours to avoid patient cancellations and losing operative volume and skill. The human cost of accreditation should be anticipated when seeking trauma center designations to avoid patient care disruptions and loss of operative experience.