Relationship between Leapfrog Safe Practices Survey and outcomes in trauma

Abstract

Objective: To examine the association between hospital self-reported compliance with the National Quality Forum patient safety practices and trauma outcomes in a nationally representative sample of level I and level II trauma centers.

Design: Retrospective cohort study using the Nationwide Inpatient Sample.

Setting: Level I and level II trauma centers.

Patients: Trauma patients.

Main outcome measures: Multivariate logistic regression models were estimated to examine the association between clinical outcomes (in-hospital mortality and hospital-associated infections) and the National Quality Forum patient safety practices. We controlled for patient demographic characteristics, injury severity, mechanism of injury, comorbidities, and hospital characteristics.

Results: The total score on the Leapfrog Safe Practices Survey was not associated with either mortality (adjusted odds ratio [aOR], 0.92; 95% confidence interval [CI], 0.79-1.06) or hospital-associated infections (1.03; 0.82-1.29). Full implementation of computerized physician order entry was not associated with reduced mortality (aOR, 1.03; 95% CI, 0.75-1.42) or with a lower risk of hospital-associated infections (0.94; 0.57-1.56). Full implementation of intensive care unit physician staffing was also not predictive of mortality (aOR, 1.13; 95% CI, 0.90-1.28) or of hospital-associated infections (1.04; 0.76-1.42).

Conclusion: In this nationally representative sample of level I and level II trauma centers, we were unable to detect evidence that hospitals reporting better compliance with the National Quality Forum patient safety practices had lower mortality or a lower incidence of hospital-associated infections.

Figure 1

Association between patient safety practices and mortality after adjusting for patient demographic characteristics (age and sex), injury severity, mechanism of injury, comorbidities, and hospital characteristics. Horizontal error bars are 95% confidence intervals (CIs). aOR indicates adjusted odds ratio; ARF, acute renal failure; CPOE, computerized physician order entry; CVC BSI, central venous cannulation bloodstream infection; DFVTIPE, deep vein thrombosis/pulmonary embolism; ICU, intensive care unit; MI, myocardial infarction; NQF, National Quality Forum; and VAP, ventilator-associated pneumonia. Surgical-site infection prevention is not presented in the figure: aOR, 0.55; 95% CI, 0.12–2.47.

Figure 2

Association between patient safety practices and hospital-associated infections after adjusting for patient demographic characteristics (age and sex), injury severity, mechanism of injury, comorbidities, and hospital characteristics. Horizontal error bars are 95% confidence intervals (CIs). For an explanation of abbreviations, see legend to Figure 1. Surgical-site infection prevention is not presented in the figure: aOR, 0.32; 95% CI, 0.05–2.13.