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Ineffective communication remains a critical issue in healthcare today, leading to worse care for patients and billions of dollars lost in inefficiencies, gaps in care, and lawsuits. One idea to improve communication is to provide patients with a direct phone line to a surgeon. Our institution trialed this idea by providing all surgical patients with a direct phone line to a general surgery resident. By surveying patients before and after implementation of the direct-access resident cell phone, we sought to determine if patients were more satisfied with their care and/or utilized hospital resources differently. Overall, we found no significant differences in patient satisfaction or perceived ease of access to care. We did, however, find that the phone line implementation decreased patients’ ED visits, readmissions, and self-reported complications. Therefore, we conclude that a direct phone line to a surgeon is beneficial in the military patient population as it is in the civilian one, and the decision to use a direct phone line, or similar other direct communication methods, should be promoted to all practices.

Ground-level falls (GLFs) are the predominant mechanism of injury in US trauma centers and accompany a spectrum of comorbidities, injury severity, and physiologic derangement. Trauma center levels define tiers of capability to treat injured patients. We hypothesized that risk-adjusted observed-to-expected mortality (O:E) by trauma center level would evaluate the degree to which need for care was met by provision of care.This retrospective cohort study used National Trauma Data Bank files for 2007-2014. Trauma center level was defined as American College of Surgeons (ACS) level I/II, ACS III/IV, State I/II, and State III/IV for within-group homogeneity. Risk-adjusted expected mortality was estimated using hierarchical, multivariable regression techniques.Analysis of 812,053 patients' data revealed the proportion of GLF in the National Trauma Data Bank increased 8.7% (14.1%-22.8%) over the 8 y studied. Mortality was 4.21% overall with a three-fold increase for those aged 60 y and older versus younger than 60 y (4.93% versus 1.46%, P 0.001). O:E was lowest for ACS III/IV, (0.973, 95% CI: 0.971-0.975) and highest for State III/IV (1.043, 95% CI: 1.041-1.044).Risk-adjusted outcomes can be measured and meaningfully compared among groups of trauma centers. Differential O:E for ACS III/IV and State III/IV centers suggests that factors beyond case mix alone influence outcomes for GLF patients. More work is needed to optimize trauma care for GLF patients across the spectrum of trauma center capability.