Rate and cost of representation in patients suffering from major trauma in Northland, New Zealand

Introduction The published rate of readmission in major trauma patients in New Zealand has been recorded at 11%. The rate of re-attendances to emergency departments (ED) is currently not reported, but potentially adds significant burden to the healthcare system. The rate, costs and resource implications of these representations have not previously been described in New Zealand. Aim The aim of this study was to define the rate, costs and resource implications of unplanned representations, re-attendance to ED and readmission in patients who have suffered from major trauma in Northland. Method We undertook a four-year retrospective study including all patients who re-attended the emergency department or who were readmitted within 30 days following discharge after major trauma presentation in Northland. Actual patient costs were calculated using in-hospital patient level costing. Length of hospital stay and utilisation of higher-level care facilities were obtained from the hospital's clinical results reporting system and data warehouse. Results 420 patients formed the primary cohort. There were 90 total representations in 63 patients (15%). The number of re-attendances to ED and readmissions was 52 (12%) and 38 (9%) respectively. The total cost associated with representation in the primary cohort was $220,914, or $55,229 per year. Median cost of re-attendance to ED was $334, and median cost of readmission was $3,643. Mean length of stay in those admitted was 1.9 days. Conclusion This study defined the rate, costs and resource implications of re-attendance to ED and readmissions in patients following admission due to major trauma. This data will help guide quality improvement and reduce costs.