Continued rationale of why hospital mortality is not an appropriate measure of trauma outcomes
- 作者：Katherine B. Kelly ; M.D. ; Megan L. Koeppel ; M.D. ; John J. Como ; M.D. ; M.S. ; Jeffrey W. Carter ; M.D. ; Andrew M. McCoy ; M.D. ; M.S. ; Jeffrey A. Claridge ; M.D. ; M.S. ; jclaridge@metrohealth.org
- 关键词：Trauma ; Outcomes ; Quality ; Mortality ; Withdrawal of care
- 刊名：The American Journal of Surgery
- 出版年：2012
- 期刊代码：9_00029610
- 类别：med
- 出版时间：March, 2012
- 卷：203
- 期：3
- 页码：366-369
- 文件大小：144 K
摘要
Background
We hypothesized that standardized withdrawal of care (WOC) practices and an aggressive long-term acute care facility (LTAC) discharge protocol could change hospital mortality and national ranking among trauma centers.Study Design
Patients who died while admitted to the trauma service at a level 1 trauma center were classified as either an 鈥淟TAC candidate鈥?or 鈥渘ot a LTAC candidate鈥?at 4 time points before death.
Results
A total of 216 patients died, and 48%had WOC. Hospital mortality was 3.3%. More than 26%of these qualified as LTAC candidates. The aggressive LTAC discharge protocol reduced hospital mortality by .9%. This was sufficient to move a trauma center into a lower quartile on the National Trauma DataBank benchmark report for 2009.
Conlusions
It is possible to reduce hospital mortality and improve quality ranking with standardized WOC and LTAC discharge protocols. This highlights the importance of measuring outcomes beyond discharge.