Organization of orthopaedic trauma services: A survey of the Orthopaedic Trauma Association

Objectives: This study was undertaken to collect information about the organization of orthopaedic trauma services in different types of hospitals, with particular emphasis on hospital support arrangements in different practice situations. Design: A survey was sent to all members of the Orthopaedic Trauma Association (OTA) as part of the organization's newsletter, Fractoids. In addition, the survey was distributed by the OTA's E-mail discussion list, ORT-1, Main Outcome Measurements: The survey included questions about the size and nature of the hospital, resident involvement, academic affiliation, number of orthopaedic physician staff, training of the staff, presence of an organized orthopaedic trauma service, distribution of call and patients, and hospital support. Results: Fifty-seven responses were received from North American centers, of which six were duplications. Responses came from institutions of all types and sizes, although most came from urban, Level 1 trauma centers with academic affiliation. Twenty-nine hospitals had a designated orthopaedic trauma service, and twenty-six had a director. Eighteen institutions had ancillary staff (nurses, physician's assistants, etc.) assigned to the orthopaedic trauma service. Hospitals with an academic affiliation were statistically more likely to have a designated orthopaedic trauma service and to distribute trauma patients by subspecialty expertise. In hospitals with a designated orthopaedic trauma service or director, it was more common to have ancillary support staff and to have it funded by the hospital, although the differences did not rise to statistical significance. Conclusions: There are differences in organization of orthopaedic trauma care between hospitals, which may be related to hospital size, academic affiliation, and orthopaedic department organization. Further study is necessary to determine whether organizational differences translate into differences in patient outcome after trauma.