XXXX outcomes in academic medical centers: influence of fellowship programs and in-house on-call attending surgeon.

@entity1 @entity1661 @entity130
BACKGROUND: There are very few data on characteristics or policies that improve @entity1 outcomes in academic medical institutions. We were interested in 2 such policies or characteristics that are commonly implemented in academic centers: an in-house on-call attending physician policy and the existence of postgraduate medical education. HYPOTHESIS: An in-house attending surgeon on-call policy and the presence of @entity130 and critical care fellowship programs improve outcomes of critically injured @entity1 . DESIGN: Multicenter cohort study. Two cohorts were analyzed: blunt @entity130 (n = 601; mortality, 16.0%) and penetrating @entity1661 (n = 503; mortality, 7.5%). SETTING: Thirty-one academic level I @entity130 centers, 10 (32.3%) with in-house on-call policy and 11 (35.5%) with fellowship programs. MAIN OUTCOME MEASURES: Mortality, hospital length of stay, and intensive care unit length of stay. RESULTS: In-house on-call surgeon policy had no impact on mortality or length of hospital or intensive care unit stay for either the blunt or penetrating @entity130 cohort. However, the presence of fellowship programs was associated with a significant decrease in blunt @entity130 mortality (odds ratio, 0.4; 95% confidence interval [CI], 0.1-0.8) and a decrease in length of intensive care unit stay (mean difference, 4.7 days; 95% CI, 0.6-8.8 days) and hospital stay (mean difference, 3.2 days; 95% CI, 0.6-5.9 days). There were no significant effects of fellowship programs on penetrating @entity130 outcomes. CONCLUSIONS: An in-house on-call attending surgeon policy is not associated with improved outcomes. In contrast, presence of a @entity130 and surgical critical care fellowship program, a potential surrogate marker for an institution that is committed to this specialty interest, is associated with improved outcomes for critically injured @entity1 . An investment in advanced postgraduate medical education has potential benefits in @entity1 care and outcomes.
