Importance of Level 1 Trauma Services in U.S. Hospitals

Subject: Nursing
Pages: 6
Words: 1403
Reading time:
5 min
Study level: College


Currently, it is important for nurses to apply evidence-based practice when addressing health issues. Given that scientists are increasingly performing studies to improve on patient outcomes, it is important for nurses to have skills to analyze study reports to help them apply evidence-based practice. This paper is a critique of a study report titled The importance of level 1 trauma services in U.S. hospitals authored by Harrison Jeffrey and McLane Colleen in 2005.

Problem statement

Nurses are key players in any health care facility because they determine the outcomes of trauma patient outcomes. The problem statement of this study is relevant because nurses can contribute substantially to reduction of the prevalence, mortality, and morbidity rate of trauma, thereby reducing its financial burden on the society. The problem statement is important because the study often has policy and treatment implications, which directly involve stakeholders.

Study purpose and Research question

The purpose of the study was to compare the features of hospitals that provide Level 1 trauma care with those that do not. The purpose of the study is important to nursing because the researchers needed to know the market share characteristics within which hospitals with level 1 trauma centre operate, and the policies related with such conditions. For instance, the law requires any trauma center to admit any severe trauma case regardless of whether the patients have paid their health insurance (Harrison & McLane, 2005, p.224). This may have serious implications on the reimbursement of Level 1 trauma centers. Nevertheless, this is not the case because hospitals with Level 1 trauma centers are situated in areas with high per capita income and low employment rates.

Nurses need to know the range of services provided in the Level 1 trauma centers, so that those who have the necessary training may seek employment in those centers. In addition, the management and profitability status of Level 1 trauma centers is important, so that nurses may weigh whether to work in them or otherwise.

Research questions

  1. To determine the nature of the market within which the Level 1 trauma centers operate in terms of per capita income, unemployment rate, elderly Medicare patient, and HMO penetration.
  2. To determine the capacity of level 1 trauma centers in terms of size of facilities and range of clinical services.
  3. To determine the status of the management of Level 1 trauma centers in terms of operating expenses per discharge and average Length of Stay (LOS).
  1. To determine the profitability of hospitals with Level 1 trauma centers relative to those without Level 1 trauma centers.


The researchers in this study used hospitals with or without Level 1 trauma center as the dependent variable. This variable is indicated by a binary symbol of 1 and 0 representing hospitals with Level 1 trauma centers and those without, respectively.

The independent variable, on the other hand, was classed into organizational variables, operating performance, and market variables. To begin with, the organizational factors include managed care contracts, clinical services, facility age and size staffed beds.

The number of staffed bed is an indicator for acute care hospital size and complexity, which is reflective of capacity for Level 1 trauma center. A high number of staffed bed means that the hospital can accommodate trauma patients.

The range of clinical services available is reflective of the organizational complexity and capacity to accommodate a Level 1 trauma center. A wide range of clinical services is associated with increased market share (Friedman & Shortell, 1988, p.240). This variable is appropriate because a wide range of clinical services implies the availability of different experts who can collaborate in the treatment of trauma case.

Facility age on the other hand is indicative of the currency of the equipment used in a hospital. Modern facility symbolizes a high quality of care and vice versa. In addition, facility age is an indicator hospital’s capital needs.

Managed care contracts indicate the sum of HMO and PPO contracts held per hospital. The more managed care contracts available the less the number of admissions and shorter length of stay [LOS] (Weinick & Cohen, 2000, p.180). This implies more room for treatment of trauma cases.

Operating performance variables include operating expenses per discharge, hospital occupancy rate, return on asset, long-term debt to equity, and average LOS. The authors measured these variables at the individual hospitals.

Variables associated with market are per capita income, percentage of traumatic cases over 65, HMO penetration and unemployment rate and they represent the need for hospital services.

Theoretical Framework

The theoretical framework used here guided the study by giving the socio-economical component affected by the traumatic injury. This gives the direction the study would take. Thus, the reader will expect the study to tackle features of the stakeholders of traumatic injuries, including personal, organizational, and public policy.

The authors also mentioned budgetary expenditures on trauma, which is quiet a lot and calls for an intensive study to establish the key factors responsible for such huge sum of expenditures. Harrison and McLane have also given mortality and morbidity rate to support the importance for the study (2005, p.223), which prepares the mind of the reader for what will transpire from the study.

The theory also describes the distribution of trauma centers in the United States and standards admission per year. The number of Level 1 trauma centers across the U.S. gives another basis for the researchers to build upon. Finally, the authors give the financial perspective of Level 1 trauma centers.

Study design

The study design is retrospective because it involved the examination of data from hospitals Level 1 trauma centers. The study design used is appropriate because it focuses the study on past records on Hospital with Level 1 trauma centers and those without, for the researchers to relate independent variables with the dependent variables.

External and internal validity

There are neither threats to internal validity nor external validity of the study. The study is a retrospective design, which relies on secondary data from the American Hospital Association (AHA), the Area Resource File (ARF), and the Center for Medicare and Medical Data Set (CMS).


The sample used in the study is extremely large because it covers the 2001 total record of a random sample of all the hospitals in the U.S. Therefore, the sample is representative of all the hospitals in the U.S. by virtue of source of data, AHA.

Data collection and analysis

The authors collected data from organizations that represent all the hospitals countrywide. Thus, the findings of the study are representative of the country’s trauma events.

The data analysis procedure is appropriate for this type of data because it helped highlight the difference between hospitals with Level 1 trauma centers and those without. Further, the correlation analysis was important to eliminate the influence of extraneous variables such as staffing and equipment.

Strength and limitation

The strength of scientific merit of the study is the use of various variables to give a full view of trauma in the United States. The other strength is the comparison of the features of hospitals with Level 1 trauma center and those that lack Level 1 trauma center.

The findings of the study are valid because they give conditions prerequisite for establishing Level 1 trauma center in hospitals. The study findings are practical for use to the extent of identifying the medical domains that are relevant for trauma and policymaking. In addition, the study highlights the useful interventions.


One implication of the study is that the government should implement drastic measures to curb the high trauma prevalence among the youth. In addition, the government should devise ways to bring Level 1 trauma centers to residents in the rural areas to sustain equity in terms of access to Level 1 trauma centre.


The skills to criticize a study report are important for nurses to be able to determine the validity and the implications of research study. This perspective is consistent with the current use of evidence-based practice to improve patient outcome and organizational profitability.

Reference list

Friedman, B., & Shortell, S. (1988). The financial performance of selected investor-Owned and not-for-profit system hospitals before and after Medicare prospective payment. Health Services Research, 23(2), 237-267.

Harrison, J. P., & McLane, C. G. (2005). The importance of level 1 trauma services in U.S. hospitals. Nursing Economic, 23(5), 223-232.

Weinick, R., & Cohen, J. (2000). Leveling the playing field: Managed care enrollment. Health Affairs, 19(3), 178-184.