Impact of trauma centre accreditation on mortality and complications in a Canadian trauma system: an interrupted time series analysis

2020 ◽  
pp. bmjqs-2020-011271
Author(s):  
Brice Batomen ◽  
Lynne Moore ◽  
Erin Strumpf ◽  
Howard Champion ◽  
Arijit Nandi
Keyword(s):  
Time Series ◽  
Patient Outcomes ◽  
Major Trauma ◽  
Interrupted Time Series ◽  
Trauma Centre ◽  
Case Mix ◽  
Patient Case ◽  
Trauma Centres ◽  
Level Ii ◽  
Level I

BackgroundPeriodic external accreditation visits aiming to determine whether trauma centres are fulfilling the criteria for optimal care are part of most trauma systems. However, despite the growing trend towards accreditation of trauma centres, its impact on patient outcomes remains unclear. In addition, a recent systematic review found inconsistent results on the association between accreditation and patient outcomes, mostly due to the lack of robust controls. We aim to address these gaps by assessing the impact of trauma centre accreditation on patient outcomes, specifically in-hospital mortality and complications, using an interrupted time series (ITS) design.MethodsWe included all major trauma admissions to five level I and four level II trauma centres in Quebec, Canada between 2008 and 2017. In order to perform ITS, we first obtained monthly and quarterly estimates of the proportions of in-hospital mortality and complications, respectively, for level I and level II centres. Prognostic scores were used to standardise these proportions to account for changes in patient case mix and segmented regressions with autocorrelated errors were used to estimate changes in levels and trends in both outcomes following accreditation.ResultsThere were 51 035 admissions, including 20 165 for major trauma during the study period. After accounting for changes in patient case mix and secular trend in studied outcomes, we globally did not observe an association between accreditation and patient outcomes. However, associations were heterogeneous across centres. For example, in a level II centre with worsening preaccreditation outcomes, accreditation led to −9.08 (95% CI −13.29 to −4.87) and −9.60 (95% CI −15.77 to −3.43) percentage point reductions in mortality and complications, respectively.ConclusionAccreditation seemed to be beneficial for centres that were experiencing a decrease in performance preceding accreditation.

scholarly journals Trauma system accreditation and patient outcomes in British Columbia: an interrupted time series analysis

2020 ◽  
Vol 32 (10) ◽  
pp. 677-684
Author(s):  
Brice Batomen ◽  
Lynne Moore ◽  
Erin Strumpf ◽  
Natalie L Yanchar ◽  
Jaimini Thakore ◽  
...  
Keyword(s):  
British Columbia ◽  
Time Series ◽  
Hospital Mortality ◽  
Patient Outcomes ◽  
Interrupted Time Series ◽  
Case Mix ◽  
Trauma Centers ◽  
Patient Case ◽  
Major Complications ◽  
The Impact

Abstract Objective We aim to assess the impact of several accreditation cycles of trauma centers on patient outcomes, specifically in-hospital mortality, complications and hospital length of stay. Design Interrupted time series. Setting British Columbia, Canada. Participants Trauma patients admitted to all level I and level II trauma centers between January 2008 and March 2018. Exposure Accreditation. Main Outcomes and Measures We first computed quarterly estimates of the proportions of in-hospital mortality, complications and survival to discharge standardized for change in patient case-mix using prognostic scores and the Aalen–Johansen estimator of the cumulative incidence function. Piecewise regressions were then used to estimate the change in levels and trends for patient outcomes following accreditation. Results For in-hospital mortality and major complications, the impact of accreditation seems to be associated with short- and long-term reductions after the first cycle and only short-term reductions for subsequent cycles. However, the 95% confidence intervals for these estimates were wide, and we lacked the precision to consistently conclude that accreditation is beneficial. Conclusions Applying a quasi-experimental design to time series accounting for changes in patient case-mix, our results suggest that accreditation might reduce in-hospital mortality and major complications. However, there was uncertainty around the estimates of accreditation. Further studies looking at clinical processes of care and other outcomes such as patient or health staff satisfaction are needed.

scholarly journals Impact of Defaulting to Single-Lumen Peripherally Inserted Central Catheters on Patient Outcomes: An Interrupted Time Series Study

2018 ◽  
Vol 67 (6) ◽  
pp. 954-957 ◽  
Author(s):  
Philip W Lam ◽  
Cheryl Volling ◽  
Tiffany Chan ◽  
J Bradley Wiggers ◽  
Lucas Castellani ◽  
...  
Keyword(s):  
Time Series ◽  
Patient Outcomes ◽  
Interrupted Time Series ◽  
Peripherally Inserted Central Catheters ◽  
Time Series Study ◽  
Single Lumen ◽  
Series Study ◽  
Central Catheters

A trauma quality improvement programme associated with improved patient outcomes: 21 years of experience at an Australian Major Trauma Centre

Injury ◽  
2014 ◽  
Vol 45 (5) ◽  
pp. 830-834 ◽  
Author(s):  
Michael M. Dinh ◽  
Kendall J. Bein ◽  
Belinda J. Gabbe ◽  
Christopher M. Byrne ◽  
Jeffrey Petchell ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Outcomes ◽  
Major Trauma ◽  
Trauma Centre ◽  
Years Of Experience ◽  
Quality Improvement Programme ◽  
Major Trauma Centre ◽  
Improvement Programme

scholarly journals Models of care for traumatically injured patients at trauma centres in British Columbia: variability and sustainability

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 200-206 ◽  
Author(s):  
Benjamin Tuyp ◽  
Kasra Hassani ◽  
Lisa Constable ◽  
Joseph Haegert
Keyword(s):  
Trauma Care ◽  
Trauma System ◽  
Models Of Care ◽  
Short Stay ◽  
Trauma Centres ◽  
Trauma Unit ◽  
Trauma Service ◽  
Level Ii ◽  
Level I ◽  
Injured Patients

AbstractBackgroundSuccessful trauma systems employ a network of variably-resourced hospitals, staffed by experienced providers, to deliver optimal care for injured patients. The “model of care”—the manner by which inpatients are admitted and overseen, is an important determinant of patient outcomes.ObjectivesTo describe the models of inpatient trauma care at British Columbia’s (BC’s) ten adult trauma centres, their sustainability, and their compatibility with accreditation guidelines.MethodsQuestionnaires were distributed to the trauma medical directors at BC’s ten Level I-III adult trauma centres. Follow-up semi-structured interviews clarified responses.ResultsThree different models of inpatient trauma care exist within BC. The “admitting trauma service” was a multidisciplinary team providing exclusive care for injured patients. The “on-call consultant” assisted with Emergency Department (ED) resuscitation before transferring patients to a non-trauma admitting service. The single “short-stay trauma unit” employed on-call consultants who also oversaw a 48-hour short-stay ward.Both level I trauma centres utilized the admitting trauma service model (2/2). All Level II sites employed an on-call consultant model (3/3), deviating from Level II trauma centre accreditation standards. Level III sites employed all three models in similar proportions. None of the on-call consultant sites believed their current care model was sustainable. Inadequate compensation, insufficient resources, and difficulty recruiting physicians were cited barriers to sustainability and accreditation compliance.ConclusionsThree distinct models of care are distributed inconsistently across BC’s Level I-III trauma hospitals. Greater use of admitting trauma service and short-stay trauma unit models may improve the sustainability and accreditation compliance of our trauma system.

Time to computed tomography: does this affect trauma patient outcomes? A retrospective analysis at an Australian major trauma centre

2019 ◽  
Vol 89 (11) ◽  
pp. 1475-1479
Author(s):  
Cedric L. H. Ng ◽  
Jason Kim ◽  
Ben Dobson ◽  
Don Campbell ◽  
Martin Wullschleger
Keyword(s):  
Computed Tomography ◽  
Trauma Patient ◽  
Retrospective Analysis ◽  
Patient Outcomes ◽  
Major Trauma ◽  
Trauma Centre ◽  
Major Trauma Centre

Patient Outcomes at Urban and Suburban Level I Versus Level II Trauma Centers

2017 ◽  
Vol 70 (2) ◽  
pp. 161-168 ◽  
Author(s):  
Amy H. Kaji ◽  
Nichole Bosson ◽  
Marianne Gausche-Hill ◽  
Aaron J. Dawes ◽  
Brant Putnam ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Trauma Centers ◽  
Level Ii ◽  
Versus Level ◽  
Level I

scholarly journals (P2-18) ICU Surge Capacity in Australian Major Trauma Centres

2011 ◽  
Vol 26 (S1) ◽  
pp. s141-s141
Author(s):  
O.M. Rigby
Keyword(s):  
Intensive Care ◽  
Online Survey ◽  
Major Trauma ◽  
Participation Rate ◽  
Mass Casualty ◽  
Trauma Centre ◽  
Cross Sectional ◽  
Surge Capacity ◽  
Trauma Centres ◽  
Elective Surgical Procedures

IntroductionMass casualty incidents (MCIs), requiring Trauma critical care, are increasingly likely. The ability to scale operations up i.e. ‘surge capacity’, is vital for ensuring scarce resources are used efficiently. The number of intensive care unit (ICU) beds is one of the key resources and indicators of a hospital's capacity and thus a vital area to target when assessing a systems ability to surge its Trauma ICU capabilities.ObjectiveThe study attempted to assess whether ICU facilities at major hospitals in large Australian cities would be able to respond to an event on the magnitude of the Madrid tragedy. This is the first report to measure Australia's major hospitals intensive care trauma surge capacity using Madrid as a standard.MethodsIn this prospective, cross-sectional analysis, we conducted a survey of major urban ICU trauma centres in the 8 state and Territory Capital cities of Australia. 14 Trauma Centre ICU's were targeted. The study was composed of two parts, A & B. Part A of the study consisted of an online survey, Part B, consisted of a follow-up telephone questionnaire. Full Ethics approval was sought and obtained.ResultsThere were 8 replies to the survey giving a 57% participation rate. At the time of this snap-shot survey the total number of Physically available ICU beds throughout the 8 Level I trauma centres was 52.5. All hospitals had at least 3 spare beds. This ranged from 3 to 10 beds. After accounting for the flux in beds post admissions & discharges there was a 21% increase in bed availability, which was further increased by a magnitude of 28% to an average of 10.125 beds, if all elective surgical procedures were cancelled. When using the Madrid ICU surge (29 new ICU patients) as a gold standard against which to compare, it was found the largest trauma ICU in Australia could have managed 62% of this surge. On average the 8 trauma centres would have handled only 34.75% of the Madrid ICU surge.ConclusionsIn the event of a major traumatic disaster on the scale of the Madrid atrocity, few if any of Australia's major trauma centres have the capacity to cope with the requisite surge. More research and novel ways of addressing this challenge are needed.

scholarly journals Fibular nails for open and closed ankle fractures: Results from a non-designer level I major trauma centre

2019 ◽  
Vol 27 (1) ◽  
pp. 230949901983242 ◽  
Author(s):  
Bilal Al-Obaidi ◽  
Anatole Vilhelm Wiik ◽  
Rahul Bhattacharyya ◽  
Nadeem Mushtaq ◽  
Rajarshi Bhattacharya
Keyword(s):  
Major Trauma ◽  
Trauma Centre ◽  
Ankle Fractures ◽  
Major Trauma Centre ◽  
Level I

scholarly journals LO66: The effect of Alberta’s new impaired driving legislation on motor vehicle-related trauma

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S30-S30
Author(s):  
L. S. Rollick ◽  
B. Nakashima ◽  
M. Frey ◽  
I. Wishart
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Motor Vehicle ◽  
Interrupted Time Series ◽  
Trauma Team ◽  
Trauma Centre ◽  
Interrupted Time Series Analysis ◽  
Impaired Driving ◽  
Traumatic Injuries ◽  
Series Analysis

Introduction: Motor vehicle collisions (MVCs) resulting in injuries and death disproportionately involve impaired drivers. Those under the influence of alcohol also have a higher rate of presentation and admission to hospital for traumatic injuries. In an attempt to decrease impaired driving and alcohol-related MVCs and injuries, the government of Alberta introduced stricter impaired driving legislation in the summer of 2012. It has yet to be determined what impact this new legislation has had on traumatic injuries secondary to MVCs and alcohol impairment. The objective of this study was to assess the relationship between the implementation of the new legislation and the proportion of alcohol-related MVC trauma presenting to the emergency department of a Level I Trauma Centre. Methods: A retrospective single centre cross-sectional chart review examining adult patients presenting to the ED of a major trauma centre who: a) require trauma team activation or consultation and b) have a MVC related injury. Of those charts meeting these criteria, the proportion of patients with positive blood alcohol concentration (BAC) was compared between the year before and the four years after implementation of the new legislation. Patients were identified using electronic medical record logs. We compared the proportion of impaired drivers by year using the SPSS software package and conducted an interrupted time series analysis in order to determine whether the implementation of the law directly affected the measured outcomes. Results: 1470 total MVC related trauma patients were identified during the study period (468 prior to legislation implementation [2010-2012] and 1002 after [2012-2016]). The proportion of drivers with BAC defined as legally impaired decreased significantly over this time period (p=0.003). Based on preliminary interrupted time series analysis we cannot conclude that the implementation of the new laws led to this significant change (p=0.524). When analyzing drivers between 16 to 25 years old, we noted a non-significant but notable decrease in the proportion of impaired drivers from 45.9% in 2011 to 21.1% in 2016 (p=0.173). Conclusion: While an impact was not seen immediately following the implementation of Alberta’s new impaired driving legislation, the proportion of impaired drivers requiring trauma team activation has decreased significantly since enactment of the new legislation from 28.9% in 2011 to 16.9% in 2016. However, based on interrupted time series analysis we cannot conclude the new legislation independently influenced this change. The impact of other factors including public education, societal preferences and generational changes cannot be excluded. There continues to be a dramatic decrease in the proportion of impaired drivers presenting with MVC related trauma under 25 years old This has not yet reached statistical significance probably due to small sample size but the trend is most prominent in this age group.

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