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Benchmarking outcomes in the critically injured trauma patient and the effect of implementing standard operating procedures.

ABSTRACT: 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).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.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.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.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.

SUBMITTER: Cuschieri J

PROVIDER: S-EPMC3327791 | biostudies-literature | 2012 May

REPOSITORIES: biostudies-literature

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Benchmarking outcomes in the critically injured trauma patient and the effect of implementing standard operating procedures.

Cuschieri Joseph J Johnson Jeffrey L JL Sperry Jason J West Michael A MA Moore Ernest E EE Minei Joseph P JP Bankey Paul E PE Nathens Avery B AB Cuenca Alex G AG Efron Philip A PA Hennessy Laura L Xiao Wenzhong W Mindrinos Michael N MN McDonald-Smith Grace P GP Mason Philip H PH Billiar Timothy R TR Schoenfeld David A DA Warren H Shaw HS Cobb J Perren JP Moldawer Lyle L LL Davis Ronald W RW Maier Ronald V RV Tompkins Ronald G RG

Annals of surgery 20120501 5

<h4>Objective</h4>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).<h4>Background</h4>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.<h4>Methods</h4>We followed ...[more]

PMID: 22470077

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Project description:BackgroundInterventions for insomnia that also address autonomic dysfunction are needed.ObjectiveWe evaluate Cereset Research™ Standard Operating Procedures (CR-SOP) in a pilot randomized, controlled trial. CR-SOP is a less operator-dependent, more generalizable innovation of HIRREM®, a noninvasive, closed-loop, allostatic, acoustic stimulation neurotechnology demonstrated to improve insomnia and autonomic function.MethodsAdults with Insomnia Severity Index (ISI) scores of ≥8 were randomized to receive ten sessions of CR-SOP, with tones linked to brainwaves (LB, intervention), or a sham condition of random tones not linked to brainwaves (NL, control). Measures were collected at enrollment and 0-14 days and 4-6 weeks post-allocated intervention. The primary outcome was differential change in ISI from baseline to 4-6 weeks post-intervention. Secondary self-report measures assessed sleep quality65 and behavioral outcomes. Ten-minute recordings of heart rate and blood pressure were collected to analyze autonomic function (heart rate variability [HRV] and baroreflex sensitivity).ResultsOf 22 randomized, 20 participants completed the allocated condition. Intention to treat analysis of change from baseline to the 4-6 week outcome demonstrated mean ISI score reduction of 4.69 points among controls (SE 1.40). In the intervention group, there was an additional 2.58 point reduction in ISI score (SE 2.13; total reduction of 7.27, P = .24). Sleep quality and some measures of autonomic function improved significantly among the intervention group compared to control.ConclusionsThis pilot study compared use of a standardized, allostatic, acoustic neurotechnology intervention with a sham, active control condition. The magnitude of change in insomnia severity was clinically relevant and similar to the findings in a prior, fully powered trial, but the differential improvement observed was not statistically significant. Significant improvements were demonstrated in sleep quality and some autonomic function measures.

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Benchmarking outcomes in the critically injured trauma patient and the effect of implementing standard operating procedures.

Publications

Benchmarking outcomes in the critically injured trauma patient and the effect of implementing standard operating procedures.

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