Kendrick A, Ciraulo D, Radeker T, et al. The American Surgeon. 2006;72:224-227.

REVIEWER INTRODUCTION

Maintaining continuity of care and meeting the unique challenges posed by trauma patients has become difficult for some surgical programs since the incorporation of the 80-hour resident workweek mandated by the Accreditation Council for Graduate Medical Education. This article presents one trauma centers' unique approach to solving this problem by using trauma nurse specialists (TNSs).

ABSTRACT

The authors of this article studied the amount of resident work hours saved per month at a hospital that employed TNSs. The level I trauma center trained a group of registered nurses to respond to trauma calls in the emergency department, assist the surgeons and residents on the floor, and perform specific procedures. Each TNS had a 3-month credentialing and orientation period. The chief resident or attending physician was responsible for teaching the advanced skills to the TNS. Two TNSs worked each 12-hour shift, providing 24-hour coverage. The TNSs were required to abstain from performing procedures during the first 2 weeks of each academic year to ensure that the incoming house staff had an opportunity to meet their educational requirements.

Both the residents and the TNS maintained procedure logs. The TNS maintained logs for 12 months, whereas the residents maintained logs for only 4 months. In total, 423 procedures were completed during the study period. The residents performed 98 procedures, and the TNS performed 325 procedures. The study found that an average of 42 hours per month was spent by the TNS performing advanced procedures. There was no statistical difference in the number of complications or the time it took to perform the procedures as compared with the residents.

COMMENTARY

Level I trauma centers are challenged to meet patient and family needs while maintaining an 80-hour resident workweek. Although there has been much written about physician's assistants and advanced practice nurses assisting in this area, this is the first article written with a unique solution of training registered nurses without advanced degrees or certification to perform certain tasks and procedures. This presents a cost-effective alternative that maintains quality and continuity of care and does not interfere with the academic goals of a surgical residency program. However, more studies are needed to look at the long-term effects of such a program and the impact on morbidity, mortality, and patient/family satisfaction.