Trauma outcomes

Trauma performance improvement and patient safety programs

Trauma centers and systems need to have the administrative infrastructure to continuously monitor and measure the outcomes of the care they deliver in order to identify and implement structural or process improvements where necessary and reduce harm. These programs can provide the required programmatic elements to effectively identify relevant issues, develop corrective actions, and assess problem resolution, outcome improvements, and patient safety. As well, these programs should be integrated into the institutional Performance Improvement and Patient Safety (PIPS) program as well as the regional and state trauma system where present. The essential structure and processes of these trauma PIPS programs are outlined in the current edition of the ACSCOT Resources for Optimal Care of the Injured Patient .

Trauma registries

In order to monitor and analyze the outcomes of their patients, trauma centers must be supported by a reliable method of data collection from the electronic medical record to assure valid and objective information. This process constitutes a hospital or system trauma registry that can provide routine reporting and internal benchmarking of specified outcome measures and identify variances in the process of care. In addition, participation in regional, state, or other national trauma databases including the National Trauma Data Bank (NTDB) can allow for comparative analysis and external benchmarking. However, it is important to recognize these databases constitute a convenience sample and should not be considered a population-based assessment of U.S./Canadian trauma care.

Since 2007, in order to address the nonuniformity of the NTDB’s data, all U.S. and Canadian trauma center registries have been required to use the National Trauma Data Standard (NTDS, see https://www.facs.org/quality-programs/trauma/quality/national-trauma-data-bank/national-trauma-data-standard/data-dictionary/access/ ). This data dictionary managed and updated annually by ACSCOT provides uniform definitions for the trauma patient, including outcomes and processes related to acute care of the hospitalized trauma patient.

Trauma quality improvement program

In 2006, ACSCOT established a work group to design, test, and validate a risk-adjusted, outcomes-based program to measure and improve the quality of trauma care. This effort has led to the establishment of the Trauma Quality Improvement Program (TQIP, see https://www.facs.org/quality-programs/trauma/quality/trauma-quality-improvement-program/ ). TQIP utilizes the NTDS data elements from participating pediatric and adult trauma centers to provide biannual reports consisting of risk-adjusted benchmarking of selective hospitalized patient cohorts for mortality and major complications. These benchmarks are determined by ratios of the observed patient outcomes to those that are expected (O/E ratios) based on a validated multiple logistic regression model. These O/E ratios with 90% confidence intervals are plotted such that each center can readily assess its own performance compared to its peers. In addition, through this methodology, top performing centers can be identified and best practices determined. ( https://www.facs.org/quality-programs/trauma/quality/best-practices-guidelines/ ).

Outcomes