title: Variation in hospital complication rates and failure-to-rescue for trauma patients.
abstract: OBJECTIVE
  To examine whether failure-to-rescue is an important mechanism driving outcome differences across low- and high-mortality hospitals caring for trauma patients.
  
  
  BACKGROUND
  Reducing medical errors and complications has become the focus of quality improvement efforts. Patients undergoing general and vascular surgery in high-mortality hospitals have similar rates of complications but higher failure-to-rescue rates compared to patients in low-mortality hospitals.
  
  
  METHODS
  Retrospective cohort study based on 54,713 patient records in the National Trauma Databank in 2007. Hospitals were classified as low-mortality, average, and high-mortality hospitals using the Trauma Mortality Probability Model. Regression modeling was used to explore the impact of hospital quality ranking on the incidence of major complications and on the incidence of failure-to-rescue (death after a major complication), adjusting for injury severity, mechanism of trauma, and patient physiology.
  
  
  RESULTS
  Trauma patients in low-mortality hospitals had similar unadjusted rates of major complications compared to patients in high-mortality hospitals (5.9% vs. 5.5%). However, patients in low-mortality hospital had a lower failure-to-rescue rate compared to patients in high-mortality hospitals (adj OR 0.26: 95% CI 0.20, 0.39)
  
  
  CONCLUSIONS
  Our findings suggest that the primary driver of differences in hospital quality for trauma patients is failure-to-rescue as opposed to differences in complication rates. Achieving lower mortality rates in trauma patients may require reducing both the incidence of major complications and the incidence of death after major complications.
authors.affiliation: University of Rochester School of Medicine, NY, USA. Laurent_Glance@urmc.rochester.edu
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.forename: J Wayne
authors.initials: JW
authors.lastname: Meredith
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000704:Analysis of Variance; D001499:Bayes Theorem; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000592:standards* / Q000639:trends; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D011786:Quality Control; D058996:Quality Improvement; D012189:Retrospective Studies; D017678:Sex Distribution; D016019:Survival Analysis; D017211:Treatment Failure; D014481:United States; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D055815:Young Adult