A twelve-year analysis of disease and provider complications on an organized level I trauma service: as good as it gets?
BACKGROUND
The development of trauma systems reduces preventable mortality and the measurement of standardized complications creates further opportunity for improvement in morbidity. The annual incidence of complications in a trauma population has been previously reported but the frequency change over time in a single institution is not well studied.


METHODS
All patients who were hospitalized for more than 24 hours, who died, were admitted to the Intensive Care Unit (ICU) or Intermediate Care Unit (IMU), or were inter-facility transfers prospectively evaluated for 12 consecutive years. A total of 13,382 patients were studied (range, 862-1234 patients per year). Complication events were collected using 135 standardized definitions including disease and provider outcomes.


RESULTS
The overall incidence of complications has remained stable over time. Provider events, disease events, and patients developing three or more complications have remained unchanged as well. Specific disease complications including pneumonia, deep vein thrombosis (DVT), and small bowel obstruction have fallen over time. Improvements in provider errors have also occurred.


CONCLUSIONS
This data suggests that most complications have a finite threshold despite the use of a stable trauma staff, implementation of standardized protocols, and emphasis on consistency of practice. Further reductions will require new research for disease-related treatment and new strategies for consistency and error reduction rather than our current models of continuous quality improvement.
Hoyt
David B
DB
Division of Trauma, Department of Surgery, University of California San Diego, San Diego, California 92103-8896, USA. dhoyt@uscd.edu.
Coimbra
Raul
R
Potenza
Bruce
B
Doucet
Jay
J
Fortlage
Dale
D
Holingsworth-Fridlund
Peg
P
Holbrook
Troy
T
D000046:Academic Medical Centers / Q000706:statistics & numerical data / Q000639:trends; D002140:California / Q000453:epidemiology; D003951:Diagnostic Errors / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006302:Health Services Research; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D015601:Injury Severity Score; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008485:Medical Audit; D019300:Medical Errors / Q000706:statistics & numerical data* / Q000639:trends; D009104:Multiple Trauma / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology