Role of ED crowding relative to trauma quality care in a Level 1 Trauma Center - 24/03/19
, Richard D. Robinson, MD a , Therese M. Duane, MD b , Jessica J. Kirby, D.O a , Cassie Lyell, RN b , Stefan Buca, MD a , Rajesh Gandhi, MD b , Shaynna M. Mann, MD a , Nestor R. Zenarosa, MD a , Hao Wang, MD, PhD a, ⁎ Abstract |
Objective |
Trauma Quality Improvement Program participation among all trauma centers has shown to improve patient outcomes. We aim to identify trauma quality events occurring during the Emergency Department (ED) phase of care.
Methods |
This is a single-center observational study using consecutively registered data in local trauma registry (Jan 1, 2016–Jun 30, 2017). Four ED crowding scores as determined by four different crowding estimation tools were assigned to each enrolled patient upon arrival to the ED. Patient related (age, gender, race, severity of illness, ED disposition), system related (crowding, night shift, ED LOS), and provider related risk factors were analyzed in a multivariate logistic regression model to determine associations relative to ED quality events.
Results |
Total 5160 cases were enrolled among which, 605 cases were deemed ED quality improvement (QI) cases and 457 cases were ED provider related. Similar percentages of ED QI cases (10–12%) occurred across the ED crowding status range. No significant difference was appreciated in terms of predictability of ED QI cases relative to different crowding status after adjustment for potential confounders. However, an adjusted odds ratio of 1.64 (95% CI, 1.17–2.30, p < 0.01) regarding ED LOS ≥2 h predictive of ED related quality issues was noted when analyzed using multivariate logistic regression.
Conclusion |
Provider related issues are a common contributor to undesirable outcomes in trauma care. ED crowding lacks significant association with poor trauma quality care. Prolonged ED LOS (≥2 h) appears to be linked with unfavorable outcomes in ED trauma care.
Le texte complet de cet article est disponible en PDF.Keywords : Quality, Trauma, Emergency Department, Crowding, Length of stay
Plan
Vol 37 - N° 4
P. 579-584 - avril 2019 Retour au numéro
Article précédent
- Optimal sequence of surgical procedures for hemodynamically unstable patients with pelvic fracture: A network meta-analysis
- Jingli Tang, Zhanying Shi, Juzheng Hu, Hao Wu, Chengzhi Yang, Guoping Le, Jinmin Zhao
- Prehospital advanced cardiac life support by EMT with a smartphone-based direct medical control for nursing home cardiac arrest
- Changsun Kim, Hyuk Joong Choi, Hyungjun Moon, Giwoon Kim, Choungah Lee, Jin Sung Cho, Seongjung Kim, Kyoungmi Lee, Hanjoo Choi, Wonjung Jeong
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?