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Monitoring hospital trauma mortality using statistical process control methods

D E Clark1, B M Cushing, C E Bredenberg

  • 1Department of Surgery, Maine Medical Center, Portland 04102, USA.

Journal of the American College of Surgeons
|June 19, 1998
PubMed
Summary
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Statistical process control effectively monitors trauma mortality trends. This method identified significant improvements in survival from neurologic deterioration, aiding quality improvement efforts.

Area of Science:

  • Medical Quality Improvement
  • Trauma Care Research
  • Statistical Analysis in Medicine

Background:

  • Developing effective methods for monitoring trauma mortality trends is crucial for healthcare quality.
  • Objective clinical categories and statistical process control (SPC) offer a robust framework for such monitoring.

Purpose of the Study:

  • To develop and evaluate a simple, effective method for monitoring trends in trauma mortality.
  • To apply statistical process control (SPC) to trauma mortality data for identifying areas of concern and improvement.

Main Methods:

  • Control charts and Pareto analysis were applied to trauma mortality data from 1975-1996 at Maine Medical Center.
  • Exclusion criteria included age over 80, severe neurological impairment, and specific comorbidities; deaths were categorized into inability to resuscitate, neurologic deterioration, or organ failure.

Related Experiment Videos

  • Annual mortality data were analyzed using the hypothesis of stationary Poisson processes, comparing observed rates to historical data (1975-1984).

    • Main Results:

    • Overall trauma mortality remained within expected control limits according to the Poisson model after exclusions.
    • A statistically significant improvement trend was observed in mortality due to neurologic deterioration.
    • Pareto analysis highlighted specific areas, such as aortic and liver trauma, warranting further detailed investigation despite not exceeding control limits.

    Conclusions:

    • Statistical process control (SPC) methodology is straightforward to implement in a hospital setting.
    • This approach is potentially valuable for ongoing surveillance and quality improvement in trauma mortality management.