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Al-Thani H, El-Menyar A, Khan NA, Consunji R, Mendez G, Abulkhair TS, Mollazehi M, Peralta R, Abdelrahman H, Chughtai T, Rizoli S. Trauma Quality Improvement Program: A Retrospective Analysis from A Middle Eastern National Trauma Center. Healthcare (Basel) 2023; 11:2865. [PMID: 37958008 PMCID: PMC10649144 DOI: 10.3390/healthcare11212865] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The Trauma Quality Improvement Program (American College of Surgery (ACS-TQIP)) uses the existing infrastructure of the Committee on Trauma programs and provides feedback to participating hospitals on risk-adjusted outcomes. This study aimed to analyze and compare the performance of the Level I Hamad Trauma Centre (HTC) with other TQIP participating centers by comparing TQIP aggregate database reports. The primary goal was to pinpoint the variations in adult trauma outcomes and quality measures, identify areas that need improvement, and leverage existing resources to facilitate quality improvement. METHODS A retrospective analysis was performed for the TQIP data from April 2019-March 2020 to April 2020-March 2021. We used the TQIP methodology, inclusion and exclusion criteria, and outcomes. RESULTS There were 915 patients from Fall 2020 and 884 patients from Fall 2021 that qualified for the TQIP database. The HTC patients' demographics differed from the TQIP's aggregate data; they were younger, more predominantly male, and had significantly different mechanisms of injury (MOI) with more traffic-related blunt trauma. Penetrating injuries were more severe in the other centers. During the TQIP Fall 2020 report, the HTC was a low outlier (good performer) in one cohort (all patients) and an average performer in the remaining cohorts. However, during Fall 2021, the HTC showed an improvement and was a low outlier in two cohorts (all patients and severe TBI patients). Overall, the HTC remained an average performer during the report cycles. CONCLUSIONS There was an improvement over time in the risk-adjusted mortality, which reflects the continuous and demanding effort put together by the trauma team. The ACS-TQIP for the external benchmarking of quality improvement could be a contributor to better monitored patient care. Evaluating the TQIP data with emphases on appropriate methodologies, quality measurements, corrective measures, and accurate reporting is warranted.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad Medical Corporation, Doha 3050, Qatar;
- Department of Clinical Medicine, Weill Cornell Medicine, Doha 3050, Qatar
| | - Naushad Ahmad Khan
- Clinical Research, Trauma & Vascular Surgery Section, Hamad Medical Corporation, Doha 3050, Qatar;
| | - Rafael Consunji
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Gladys Mendez
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Tarik S. Abulkhair
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Monira Mollazehi
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo 10100, Dominican Republic
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Talat Chughtai
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha 3050, Qatar; (H.A.-T.); (R.C.); (G.M.); (T.S.A.); (M.M.); (R.P.); (H.A.); (T.C.); (S.R.)
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Abstract
Efforts to improve quality in healthcare have arisen from the recognition that the quality of care delivered and resulting outcomes are highly variable. Performance benchmarking using high-quality data to compare risk-adjusted outcomes between hospitals and surgeons has been widely adopted as one means for addressing this problem. In this article we discuss the history, current state, methodologies, and potential pitfalls of benchmarking efforts to improve quality of healthcare in the United States.
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Affiliation(s)
- James P Byrne
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, Sheikh Zayed 6107 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, Sheikh Zayed 6107 1800 Orleans Street, Baltimore, MD 21287, USA. https://twitter.com/elliotthaut
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Ali A, Tatum D, Olubowale OO, McGrew PR, Duchesne J, Taghavi S. Thromboembolic Outcomes in Tetrahydrocannabinol-Positive Trauma Patients With Traumatic Brain Injury. J Surg Res 2022; 275:194-202. [PMID: 35305485 DOI: 10.1016/j.jss.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/12/2022] [Accepted: 02/04/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a significant source of morbidity and mortality in the United States. Recent shifts in state legislation have increased the use of recreational and medical marijuana. While cannabinoids and tetrahydrocannabinol (THC) have known anti-inflammatory effects, the impact of preinjury THC use on clinical outcomes in the setting of severe TBI is unknown. We hypothesized that preinjury THC use in trauma patients suffering TBI would be associated with decreased thromboembolic events and adverse outcomes. METHODS The American College of Surgeons Trauma Quality Improvement Program was used to identify patients aged ≥18 y with TBI and severe injury (Injury Severity Score ≥ 16) in admit year 2017. Patients with smoking or tobacco history or missing or positive toxicology tests for drug and/or alcohol use other than THC were excluded. Propensity score matching was used to compare THC+ patients to similar THC- patients. RESULTS A total of 13,266 patients met inclusion criteria, of which 1669 were THC+. A total of 1377 THC+ patients were matched to 1377 THC- patients. No significant differences were found in in-hospital outcomes, including mortality, length of stay, cardiac arrest, pulmonary embolism, deep vein thrombosis, or acute respiratory distress syndrome. No patients had ischemic stroke, and THC+ patients had significantly decreased rates of hemorrhagic stroke (0.5% versus 1.5%, P = 0.02, odds ratio 0.41 [95% confidence interval 0.18-0.86]). CONCLUSIONS Preinjury THC use may be associated with decreased hemorrhagic stroke in severely injured patients with TBI, but there was no difference in thromboembolic outcomes. Further research into pathophysiological mechanisms related to THC are needed.
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Affiliation(s)
- Ayman Ali
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Danielle Tatum
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana; Trauma Specialist Program, Our Lady of the Lake RMC, Baton Rouge, Louisiana
| | - Olayemi O Olubowale
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Patrick R McGrew
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Juan Duchesne
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Sharven Taghavi
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
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Brochhausen M, Ball JW, Sanddal ND, Dodd J, Braun N, Bost S, Utecht J, Winchell RJ, Sexton KW. Collecting data on organizational structures of trauma centers: the CAFE web service. Trauma Surg Acute Care Open 2020; 5:e000473. [PMID: 32789188 PMCID: PMC7394144 DOI: 10.1136/tsaco-2020-000473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/03/2020] [Accepted: 06/28/2020] [Indexed: 11/04/2022] Open
Abstract
Background During the past several decades, the American College of Surgeons has led efforts to standardize trauma care through their trauma center verification process and Trauma Quality Improvement Program. Despite these endeavors, great variability remains among trauma centers functioning at the same level. Little research has been conducted on the correlation between trauma center organizational structure and patient outcomes. We are attempting to close this knowledge gap with the Comparative Assessment Framework for Environments of Trauma Care (CAFE) project. Methods Our first action was to establish a shared terminology that we then used to build the Ontology of Organizational Structures of Trauma centers and Trauma systems (OOSTT). OOSTT underpins the web-based CAFE questionnaire that collects detailed information on the particular organizational attributes of trauma centers and trauma systems. This tool allows users to compare their organizations to an aggregate of other organizations of the same type, while collecting their data. Results In collaboration with the American College of Surgeons Committee on Trauma, we tested the system by entering data from three trauma centers and four trauma systems. We also tested retrieval of answers to competency questions. Discussion The data we gather will be made available to public health and implementation science researchers using visualizations. In the next phase of our project, we plan to link the gathered data about trauma center attributes to clinical outcomes.
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Affiliation(s)
- Mathias Brochhausen
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Jane W Ball
- American College of Surgeons, Chicago, Illinois, USA
| | | | - Jimm Dodd
- American College of Surgeons, Chicago, Illinois, USA
| | - Naomi Braun
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Sarah Bost
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Joseph Utecht
- Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Machado-Aranda DA, Jakubus JL, Wahl WL, Cherry-Bukowiec JR, To KB, Park PK, Raghavendran K, Napolitano LM, Hemmila MR. Reduction in Venous Thromboembolism Events: Trauma Performance Improvement and Loop Closure Through Participation in a State-Wide Quality Collaborative. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.05.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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