Concurrent Case Review and Retrospective Review Using the Matrix Method Are Complementary Methods for Tracking and Improving Timeliness of Care in a Level I Trauma Center

Abstract

Ensuring timely care for patients with moderate-to-severe traumatic injury has been shown to significantly reduce the rate of injury-related mortality. Using concurrent case review and the matrix method described in the 2014 version of Resources for Optimal Care of the Injured Patient, we sought to reduce direct admissions and undertriage at our institution. We believed this would optimize outcomes for patients who may have been significantly impacted otherwise. Several process improvement initiatives were implemented throughout the study period and we calculated direct admission, overtriage, and undertriage rates bimonthly for evaluation of effectiveness and to intervene, if needed. Direct admission and undertriage rates significantly declined the last six months of our study when compared to baseline (July 2014 to December 2014; 0.80% vs 6.46%, P < 0.001 and 3.72% vs 6.71%, P = 0.002, respectively). In addition, a significant increase was observed in the overtriage rate (64.36% vs 74.20%, P = 0.002).We conclude that when implemented properly, continuous tracking of adherence to triage criteria and retrospective review of fallout cases leads to significant decline in both direct admissions and undertriage, as well as concomitant increase in overtriage.