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Derivation and validation of actionable quality indicators targeting reductions in complications for injury admissions

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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.

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Funding

No funding was received in support of this work.

Author information

Authors and Affiliations

  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

    Abakar Idriss-Hassan, Mélanie Bérubé, Amina Belcaïd, Xavier Neveu, Kahina Soltana & Lynne Moore

  2. Institut National de Santé Publique du Québec, Québec, QC, Canada

    Abakar Idriss-Hassan

  3. Faculty of Nursing, Université Laval, Québec, QC, Canada

    Mélanie Bérubé

  4. Institut national d’excellence en santé et en services sociaux, Québec, QC, Canada

    Amina Belcaïd & Julien Clément

  5. Department of Surgery, Université Laval, Québec, QC, Canada

    Julien Clément

  6. Urgences-Santé, Montréal, QC, Canada

    Gilles Bourgeois

  7. Centre de Recherche du CHU de Québec (Hôpital de l’Enfant-Jésus), Université Laval, Québec, QC, Canada

    Christine Rizzo

  8. Provincial Lead, Data, Evaluation and Analytics, Trauma Services BC, British Columbia, Canada

    Jaimini Thakore

  9. Department of Social and Preventative Medicine, Université Laval, 2325, Rue de l’Université, Québec, QC, G1V 0A6, Canada

    Lynne Moore

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  1. Abakar Idriss-Hassan
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  2. Mélanie Bérubé
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  3. Amina Belcaïd
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  4. Julien Clément
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  5. Gilles Bourgeois
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  7. Xavier Neveu
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  8. Kahina Soltana
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  9. Jaimini Thakore
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  10. Lynne Moore
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Contributions

AIH, LM, MB and AB contributed to the conception and design of the study. AIH, LM, MB, AB and XN contributed to the acquisition of data. AIH drafted the manuscript. All authors contributed to the analysis and interpretation of the data, critically revised and approved the manuscript.

Corresponding author

Correspondence to Lynne Moore.

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Conflict of interest

None of the authors have any conflicts of interest to declare.

Ethics approval

This project was approved by the research ethics committee of the CHU-de-Québec, Université Laval.

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Idriss-Hassan, A., Bérubé, M., Belcaïd, A. et al. Derivation and validation of actionable quality indicators targeting reductions in complications for injury admissions. Eur J Trauma Emerg Surg 48, 1351–1361 (2022). https://doi.org/10.1007/s00068-021-01681-5

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  • DOI: https://doi.org/10.1007/s00068-021-01681-5

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