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Relationship between Leapfrog Safe Practices Survey and outcomes in trauma.

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.