Abakar Idriss-Hassan1,2, Mélanie Bérubé1,3, Amina Belcaïd1,4, Julien Clément4,5, Gilles Bourgeois6, Christine Rizzo7, Xavier Neveu1, Kahina Soltana1, Jaimini Thakore8, Lynne Moore9,10. 1. Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada. 2. Institut National de Santé Publique du Québec, Québec, QC, Canada. 3. Faculty of Nursing, Université Laval, Québec, QC, Canada. 4. Institut national d'excellence en santé et en services sociaux, Québec, QC, Canada. 5. Department of Surgery, Université Laval, Québec, QC, Canada. 6. Urgences-Santé, Montréal, QC, Canada. 7. Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada. 8. Provincial Lead, Data, Evaluation and Analytics, Trauma Services BC, British Columbia, Canada. 9. Axe Santé des Populations et Pratiques Optimales en Santé (Population Health and Optimal Health Practices Research Unit), Traumatologie-Urgence-Soins Intensifs (Trauma-Emergency-Critical Care Medicine), Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada. lynne.moore@fmed.ulaval.ca. 10. Department of Social and Preventative Medicine, Université Laval, 2325, Rue de l'Université, Québec, QC, G1V 0A6, Canada. lynne.moore@fmed.ulaval.ca.
Abstract
PURPOSE: Approximately, one out of five patients hospitalized following injury will develop at least one hospital complication, more than three times that observed for general admissions. We currently lack actionable Quality Indicators (QI) targeting specific complications in this population. We aimed to derive and validate QI targeting hospital complications for injury admissions and develop algorithms to identify patient charts to review. METHODS: We conducted a retrospective cohort study including patients with major trauma admitted to any level I or II adult trauma center an integrated Canadian trauma system (2014-2019). We used the trauma registry to develop five QI targeting deep vein thrombosis/pulmonary embolism (DVT/PE), decubitus ulcers, delirium, pneumonia and urinary tract infection (UTI). We developed algorithms to identify patient charts to revise on consultation with a group of clinical experts. RESULTS: The study population included 14,592 patients of whom 5.3% developed DVT or PE, 2.7% developed a decubitus ulcer, 8.6% developed delirium, 14.7% developed pneumonia and 7.3% developed UTI. The indicators demonstrated excellent predictive performance (Area Under the Curve 0.81-0.87). We identified 4 hospitals with a higher than average incidence of at least one of the targeted complications. The algorithms identified on average 50 and 20 charts to be reviewed per year for level I and II centers, respectively. CONCLUSION: In line with initiatives to improve the quality of trauma care, we propose QI targeting reductions in hospital complications for injury admissions and algorithms to generate case lists to facilitate the review of patient charts.
PURPOSE: Approximately, one out of five patients hospitalized following injury will develop at least one hospital complication, more than three times that observed for general admissions. We currently lack actionable Quality Indicators (QI) targeting specific complications in this population. We aimed to derive and validate QI targeting hospital complications for injury admissions and develop algorithms to identify patient charts to review. METHODS: We conducted a retrospective cohort study including patients with major trauma admitted to any level I or II adult trauma center an integrated Canadian trauma system (2014-2019). We used the trauma registry to develop five QI targeting deep vein thrombosis/pulmonary embolism (DVT/PE), decubitus ulcers, delirium, pneumonia and urinary tract infection (UTI). We developed algorithms to identify patient charts to revise on consultation with a group of clinical experts. RESULTS: The study population included 14,592 patients of whom 5.3% developed DVT or PE, 2.7% developed a decubitus ulcer, 8.6% developed delirium, 14.7% developed pneumonia and 7.3% developed UTI. The indicators demonstrated excellent predictive performance (Area Under the Curve 0.81-0.87). We identified 4 hospitals with a higher than average incidence of at least one of the targeted complications. The algorithms identified on average 50 and 20 charts to be reviewed per year for level I and II centers, respectively. CONCLUSION: In line with initiatives to improve the quality of trauma care, we propose QI targeting reductions in hospital complications for injury admissions and algorithms to generate case lists to facilitate the review of patient charts.
Authors: Rebeca Abajas Bustillo; Francisco José Amo Setién; María Del Carmen Ortego Mate; María Seguí Gómez; María Jesús Durá Ros; César Leal Costa Journal: Eur J Trauma Emerg Surg Date: 2018-12-08 Impact factor: 3.693
Authors: Shahid Shafi; Sunni Barnes; David Nicewander; David Ballard; Avery B Nathens; Angela M Ingraham; Mark Hemmila; Sandra Goble; Melanie Neal; Michael Pasquale; John J Fildes; Larry M Gentilello Journal: J Trauma Date: 2010-12
Authors: Lynne Moore; Henry Thomas Stelfox; Alexis F Turgeon; Avery B Nathens; Natalie Le Sage; Marcel Émond; Gilles Bourgeois; Jean Lapointe; Mathieu Gagné Journal: Ann Surg Date: 2014-02 Impact factor: 12.969
Authors: Lynne Moore; François Lauzier; Henry Thomas Stelfox; John Kortbeek; Richard Simons; Gilles Bourgeois; Julien Clément; Alexis F Turgeon Journal: Ann Surg Date: 2015-12 Impact factor: 12.969
Authors: Mark R Hemmila; Jill L Jakubus; Paul M Maggio; Wendy L Wahl; Justin B Dimick; Darrell A Campbell; Paul A Taheri Journal: Surgery Date: 2008-08 Impact factor: 3.982
Authors: Lynne Moore; François Lauzier; Henry T Stelfox; John Kortbeek; Richard Simons; Simon Berthelot; Julien Clément; Gilles Bourgeois; Alexis F Turgeon Journal: JAMA Surg Date: 2016-07-01 Impact factor: 14.766