Moving from "optimal resources" to "optimal care" at trauma centers

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

Research output: Contribution to journalReview article

23 Scopus citations

Abstract

BACKGROUND: The Trauma Quality Improvement Program has shown that risk-adjusted mortality rates at some centers are nearly 50% higher than at others. This "quality gap" may be due to different clinical practices or processes of care. We have previously shown that adoption of processes called core measures by the Joint Commission and Centers for Medicare and Medicaid Services does not improve outcomes of trauma patients. We hypothesized that improved compliance with trauma-specific clinical processes of care (POC) is associated with reduced in-hospital mortality. METHODS: Records of a random sample of 1,000 patients admitted to a Level I trauma center who met Trauma Quality Improvement Program criteria (age ≥ 16 years and Abbreviated Injury Scale score ≥ 3) were retrospectively reviewed for compliance with 25 trauma-specific POC (T-POC) that were evidence-based or expert consensus panel recommendations. Multivariate regression was used to determine the relationship between T-POC compliance and in-hospital mortality, adjusted for age, gender, injury type, and severity. RESULTS: Median age was 41 years, 65% were men, 88% sustained a blunt injury, and mortality was 12%. Of these, 77% were eligible for at least one T-POC and 58% were eligible for two or more. There was wide variation in T-POC compliance. Every 10% increase in compliance was associated with a 14% reduction in risk-adjusted in-hospital mortality. CONCLUSION: Unlike adoption of core measures, compliance with T-POC is associated with reduced mortality in trauma patients. Trauma centers with excess in-hospital mortality may improve patient outcomes by consistently applying T-POC. These processes should be explored for potential use as Core Trauma Center Performance Measures.

Original languageEnglish (US)
Pages (from-to)870-877
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume72
Issue number4
DOIs
StatePublished - Apr 1 2012

Keywords

  • Core measures
  • Trauma processes of care
  • Trauma quality improvement

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Moving from "optimal resources" to "optimal care" at trauma centers'. Together they form a unique fingerprint.

  • Cite this

    Shafi, S., Rayan, N., Barnes, S., Fleming, N., Gentilello, L. M., & Ballard, D. (2012). Moving from "optimal resources" to "optimal care" at trauma centers. Journal of Trauma and Acute Care Surgery, 72(4), 870-877. https://doi.org/10.1097/TA.0b013e3182463e20