Results of a multi-institutional outcome assessment: results of a structured peer review of TRISS-designated unexpected outcomes.
The utility of TRISS as a component of trauma center quality assurance (QA) was evaluated. TRISS survival probabilities were estimated for a total of 2,023 consecutive trauma patients admitted to three level-I trauma centers during a 6-month period. A structured peer review was performed of the 50 patients (2.1%) having statistically unexpected outcomes. For 23 (18 survivors, five deaths) TRISS-designated outcomes were sustained in peer review. In 27 cases (one survivor, 26 deaths) TRISS-designated outcomes were not sustained by peer review and TRISS. Limitations were identified in each case. Peer review of unexpected outcomes identified by TRISS provided a consistent and objective QA methodology. An understanding of TRISS as an objective component of the trauma center QA process is essential in blending it with what is, at present, a largely subjective process in many hospitals. Use of TRISS standardizes the peer review process, resulting in a more reliable base for development and improvement of trauma center QA programs.
Karmy-Jones
R
R
Department of Surgery, Washington Hospital Center, Washington, DC 20010.
Copes
W S
WS
Champion
H R
HR
Weigelt
J
J
Shackford
S
S
Lawnick
M
M
Rozycki
G S
GS
Hollingsworth-Fridlund
P
P
Klein
J
J
D000293:Adolescent; D000328:Adult; D002140:California; D004219:District of Columbia; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010380:Peer Review; D016019:Survival Analysis; D013781:Texas; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D016896:Treatment Outcome