@article{ref1,
title="Continued rationale of why hospital mortality is not an appropriate measure of trauma outcomes",
journal="American journal of surgery",
year="2012",
author="Kelly, Katherine B. and Koeppel, Megan L. and Como, John J. and Carter, Jeffrey W. and McCoy, Andrew M. and Claridge, Jeffrey A.",
volume="203",
number="3",
pages="366-9; discussion 369",
abstract="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. STUDY DESIGN: Patients who died while admitted to the trauma service at a level 1 trauma center were classified as either an &quot;LTAC candidate&quot; or &quot;not a LTAC candidate&quot; 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. CONLUSIONS: 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.<p /> <p>Language: en</p>",
language="en",
issn="0002-9610",
doi="10.1016/j.amjsurg.2011.10.004",
url="http://dx.doi.org/10.1016/j.amjsurg.2011.10.004"
}