Evaluating quality indicators of tertiary care hospitals for trauma care in Japan

Trauma Patient Volume and the Quality of Care: A Scoping Review

BACKGROUND

Healthcare stakeholders in the Netherlands came to an agreement in 2022 to deal with present and future challenges in healthcare. Among others, this agreement contains clear statements regarding the concentration of trauma patients, including the minimal required number of annual severe trauma patients for Major Trauma Centers. This review investigates the effects of trauma patient volumes on several domains of the quality of healthcare.

METHODS

PubMed was searched; studies published during the last 10 years reporting quantitative data on trauma patient volume and quality of healthcare were included. Results were summarized and categorized into the quality domains of healthcare.

RESULTS

Seventeen studies were included with a total of 1,517,848 patients. A positive association between trauma patient volume and survival was observed in 11/13 studies with adjusted analyses. Few studies addressed other quality domains: efficiency (n = 5), safety (n = 2), and time aspects of care (n = 4). None covered people-centeredness, equitability, or integrated care.

CONCLUSIONS

Most studies showed a better survival of trauma patients when treated in high-volume hospitals compared to lower volume hospitals. However, the ideal threshold could not be determined. The association between trauma volume and other domains of the quality of healthcare remains unclear.

The off-hour effect in severe trauma and the structure of care delivery among Japanese emergency and critical care centers: A retrospective cohort study

BACKGROUND

The association between mortality and off-hour presentation to a medical center has been studied in relation to various diseases and settings, but little is known of what the association indicates. This study explored the association in severe trauma patients among Japanese emergency and critical care centers and their association with the structural factors of the medical center.

METHODS

We conducted a retrospective cohort study using a Japanese, nationwide administrative database and the annual emergency and critical care centers evaluation report. We included patients who were seen because of trauma, were at least 15 years old, were transferred to an emergency and critical care center by ambulance, were admitted to the intensive care unit, and were discharged between April 1, 2012 and March 31, 2017. Off-hour care was defined as initial care beginning at all times except 8 am to 6 pm on weekdays and 8 am to noon on Saturdays. We evaluated this topic using the structure-process-outcome model as proposed by Donabedian. A multilevel logistic regression analysis was performed.

RESULTS

The sample included 111,266 patients from 233 emergency and critical care centers. The adjusted mortality odds ratio for off-hour care was 0.90 (95% confidence interval: 0.85-0.96; P < .001). In the off-hour care cohort, the immediate availability of an operating room and off-hours work management including shift work introduction had adjusted mortality odds ratios of 0.85 (95% confidence interval: 0.74-0.98; P = .02) and 0.85 (95% confidence interval: 0.73-0.99; P = .04), respectively.

CONCLUSION

In Japan, severe trauma patients who received off-hour care at the emergency and critical care centers had a decreased in-hospital mortality. The immediate availability of an operating room and management of off-hours work were contributing structural factors. Process factors in off-hour care need to be considered in future research on this topic. This finding may have important applicability to other countries as well.