Concurrent Case Review and Retrospective Review Using the Matrix Method Are Complementary Methods for Tracking and...

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Healthcare Quality Improvement

Background:

• Timely care for severe traumatic injuries is critical for reducing mortality.
• Existing triage protocols may lead to undertriage and direct admissions, impacting patient outcomes.
• The "Resources for Optimal Care of the Injured Patient" (2014) provides a framework for trauma care evaluation.

Purpose of the Study:

• To reduce direct admissions and undertriage in patients with moderate-to-severe traumatic injuries.
• To optimize patient outcomes through improved trauma triage processes.
• To evaluate the effectiveness of process improvement initiatives on triage accuracy.

Main Methods:

• Concurrent case review and the matrix method were employed.
• Process improvement initiatives were implemented throughout the study.
• Direct admission, overtriage, and undertriage rates were calculated bimonthly for continuous evaluation.

Main Results:

• Direct admission rates significantly declined from 6.46% to 0.80% (P < 0.001).
• Undertriage rates significantly decreased from 6.71% to 3.72% (P = 0.002).
• Overtriage rates significantly increased from 64.36% to 74.20% (P = 0.002).

Conclusions:

• Continuous tracking of triage adherence and retrospective review of cases effectively reduces undertriage and direct admissions.
• These quality improvement strategies lead to a significant decrease in undertriage and direct admissions.
• The implemented strategies resulted in a concomitant increase in overtriage, indicating improved sensitivity in identifying critically injured patients.