Barriers to compliance with evidence-based care in trauma

Nadine Rayan, Sunni Barnes, Neil Fleming, Rustam Kudyakov, David Ballard, Larry M. Gentilello, Shahid Shafi

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND: We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose of this study was to identify patients least likely to receive optimal care. METHODS: Records of a random sample of 774 patients admitted to a Level I trauma center (2006 -2008) with moderate to severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance with 25 trauma-specific processes of care (T-POC) endorsed by Advanced Trauma Life Support, Eastern Association for the Surgery of Trauma, the Brain Trauma Foundation, Surgical Care Improvement Project, and the Glue Grant Consortium based on evidence or consensus. These encompassed all aspects of trauma care, including initial evaluation, resuscitation, operative care, critical care, rehabilitation, and injury prevention. Multivariate logistic regression was used to identify patients likely to receive recommended care. RESULTS: Study patients were eligible for a total of 2,603 T-POC, of which only 1,515 (58%) were provided to the patient. Compliance was highest for T-POC involving resuscitation (83%) and was lowest for neurosurgical interventions (17%). Increasing severity of head injuries was associated with lower compliance, while intensive care unit stay was associated with higher compliance. There was no relationship between compliance and patient demographics, socioeconomic status, overall injury severity, or daily volume of trauma admissions. CONCLUSION: Little over half of recommended care was delivered to trauma patients with moderate to severe injuries. Patients with increasing severity of traumatic brain injuries were least likely to receive optimal care. However, differences among patient subgroups are small in relation to the overall gap between observed and recommended care.

Original languageEnglish (US)
Pages (from-to)585-593
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume72
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Wounds and Injuries
Compliance
Resuscitation
Advanced Trauma Life Support Care
Abbreviated Injury Scale
Trauma Centers
Evidence-Based Medicine
Critical Care
Patient Compliance
Craniocerebral Trauma
Social Class
Adhesives
Intensive Care Units
Consensus
Rehabilitation
Logistic Models
Demography

Keywords

  • Innovation diffusion
  • Practice guidelines
  • Quality improvement

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery
  • Medicine(all)

Cite this

Rayan, N., Barnes, S., Fleming, N., Kudyakov, R., Ballard, D., Gentilello, L. M., & Shafi, S. (2012). Barriers to compliance with evidence-based care in trauma. Journal of Trauma and Acute Care Surgery, 72(3), 585-593. https://doi.org/10.1097/TA.0b013e318243da4d

Barriers to compliance with evidence-based care in trauma. / Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Kudyakov, Rustam; Ballard, David; Gentilello, Larry M.; Shafi, Shahid.

In: Journal of Trauma and Acute Care Surgery, Vol. 72, No. 3, 03.2012, p. 585-593.

Research output: Contribution to journalArticle

Rayan, N, Barnes, S, Fleming, N, Kudyakov, R, Ballard, D, Gentilello, LM & Shafi, S 2012, 'Barriers to compliance with evidence-based care in trauma', Journal of Trauma and Acute Care Surgery, vol. 72, no. 3, pp. 585-593. https://doi.org/10.1097/TA.0b013e318243da4d
Rayan N, Barnes S, Fleming N, Kudyakov R, Ballard D, Gentilello LM et al. Barriers to compliance with evidence-based care in trauma. Journal of Trauma and Acute Care Surgery. 2012 Mar;72(3):585-593. https://doi.org/10.1097/TA.0b013e318243da4d
Rayan, Nadine ; Barnes, Sunni ; Fleming, Neil ; Kudyakov, Rustam ; Ballard, David ; Gentilello, Larry M. ; Shafi, Shahid. / Barriers to compliance with evidence-based care in trauma. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 72, No. 3. pp. 585-593.
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