title: Benchmarking outcomes in the critically injured trauma patient and the effect of implementing standard operating procedures.
abstract: OBJECTIVE
  To determine and compare outcomes with accepted benchmarks in trauma care at 7 academic level I trauma centers in which patients were treated on the basis of a series of standard operating procedures (SOPs).
  
  
  BACKGROUND
  Injury remains the leading cause of death for those younger than 45 years. This study describes the baseline patient characteristics and well-defined outcomes of persons hospitalized in the United States for severe blunt trauma.
  
  
  METHODS
  We followed 1637 trauma patients from 2003 to 2009 up to 28 hospital days using SOPs developed at the onset of the study. An extensive database on patient and injury characteristics, clinical treatment, and outcomes was created. These data were compared with existing trauma benchmarks.
  
  
  RESULTS
  The study patients were critically injured and were in shock. SOP compliance improved 10% to 40% during the study period. Multiple organ failure and mortality rates were 34.8% and 16.7%, respectively. Time to recovery, defined as the time until the patient was free of organ failure for at least 2 consecutive days, was developed as a new outcome measure. There was a reduction in mortality rate in the cohort during the study that cannot be explained by changes in the patient population.
  
  
  CONCLUSIONS
  This study provides the current benchmark and the overall positive effect of implementing SOPs for severely injured patients. Over the course of the study, there were improvements in morbidity and mortality rates and increasing compliance with SOPs. Mortality was surprisingly low, given the degree of injury, and improved over the duration of the study, which correlated with improved SOP compliance.
authors.affiliation: University of Washington School of Medicine and Harborview Medical Center, Seattle, WA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cuschieri
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Johnson
authors.forename: Jason
authors.initials: J
authors.lastname: Sperry
authors.forename: Michael A
authors.initials: MA
authors.lastname: West
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Minei
authors.forename: Paul E
authors.initials: PE
authors.lastname: Bankey
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.forename: Alex G
authors.initials: AG
authors.lastname: Cuenca
authors.forename: Philip A
authors.initials: PA
authors.lastname: Efron
authors.forename: Laura
authors.initials: L
authors.lastname: Hennessy
authors.forename: Wenzhong
authors.initials: W
authors.lastname: Xiao
authors.forename: Michael N
authors.initials: MN
authors.lastname: Mindrinos
authors.forename: Grace P
authors.initials: GP
authors.lastname: McDonald-Smith
authors.forename: Philip H
authors.initials: PH
authors.lastname: Mason
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Billiar
authors.forename: David A
authors.initials: DA
authors.lastname: Schoenfeld
authors.forename: H Shaw
authors.initials: HS
authors.lastname: Warren
authors.forename: J Perren
authors.initials: JP
authors.lastname: Cobb
authors.forename: Lyle L
authors.initials: LL
authors.lastname: Moldawer
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Davis
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Tompkins
mesh_terms: D018806:APACHE; D000328:Adult; D019985:Benchmarking; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D013514:Surgical Procedures, Operative / Q000592:standards*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D055815:Young Adult