Continued rationale of why hospital mortality is not an appropriate measure of trauma outcomes.
BACKGROUND
We hypothesized that standardized withdrawal of care (WOC) practices and an aggressive long-term acute care facility (LTAC) discharge protocol could change hospital mortality and national ranking among trauma centers.


METHODS
Patients who died while admitted to the trauma service at a level 1 trauma center were classified as either an "LTAC candidate" or "not a LTAC candidate" at 4 time points before death.


RESULTS
A total of 216 patients died, and 48% had WOC. Hospital mortality was 3.3%. More than 26% of these qualified as LTAC candidates. The aggressive LTAC discharge protocol reduced hospital mortality by .9%. This was sufficient to move a trauma center into a lower quartile on the National Trauma DataBank benchmark report for 2009.


CONCLUSIONS
[corrected] It is possible to reduce hospital mortality and improve quality ranking with standardized WOC and LTAC discharge protocols. This highlights the importance of measuring outcomes beyond discharge.
MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Katherine B
KB
Kelly
Megan L
ML
Koeppel
John J
JJ
Como
Jeffrey W
JW
Carter
Andrew M
AM
McCoy
Jeffrey A
JA
Claridge
D000328:Adult; D019985:Benchmarking; D002985:Clinical Protocols / Q000592:standards; D005066:Euthanasia, Passive; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010351:Patient Discharge / Q000592:standards; D010360:Patient Transfer / Q000592:standards; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities; D014193:Trauma Centers / Q000592:standards*