BACKGROUND: As the health care system embraces value-based care, an accurate definition of the cost component of the value equation is essential. Time-driven activity-based costing (TDABC) is a bottom-up cost management method that calculates the cost of a service by tracking the time it takes to complete each step in a process. This study aims to use TDABC to calculate the costs associated with the initial resuscitation of trauma patients. METHODS: TDABC was used to measure the direct and indirect costs associated with the initial resuscitation of adult trauma patients who arrived at our Level 1 trauma center under the highest level of activation. We defined the initial resuscitation phase as the time from arrival in the trauma bay to departure for either a CT scan or the operating room. Time-stamped 360-degree video footage of each trauma resuscitation was used to calculate per-minute costs of both personnel and supplies. Indirect costs were determined using the total annual operating expenses of our institution, as reported to the Centers for Medicare and Medicaid Services. RESULTS: A total of 134 consecutive patients (mean age 36 y, 68% male) were included. The average duration of initial trauma resuscitation was 17 minutes, with an average total cost of 3, 628 per resuscitation—comprising 506 in direct costs and 3, 122 in indirect costs. CONCLUSIONS: TDABC is a valuable tool for measuring the costs associated with the trauma bay resuscitation of injured patients. This approach enables trauma centers to more accurately assess the financial aspects of patient care and identify opportunities for optimizing resource allocation during the resuscitation phase. (J Trauma Acute Care Surg. 2026;00: 00–00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved. ) LEVEL OF EVIDENCE: Economic and Value-based Evaluations; Level III.
Balde et al. (Mon,) studied this question.