Related Experiment Video
Updated: Aug 6, 2026
A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients
Published on: October 17, 2017
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.
Background:
We sought to develop a simple and effective way to monitor trends in trauma mortality, using objective clinical categories and methods of statistical process control.
Study Design:
Control charts and Pareto analysis were applied to trauma mortality data at the Maine Medical Center. We collected data prospectively on patients who died in our hospital after acute injury during 1985-1996 (and retrospectively for 1975-1984) to identify cases requiring medical quality review. We excluded from this study patients older than 80 years, those whose Glasgow Coma Scale motor component was never > 3 at any time after admission, and those with pathologic fractures, carcinomatosis, high quadriplegia, or severe burns. The remaining deaths were classified as resulting from inability to resuscitate (mostly hemorrhage), neurologic deterioration, or organ failure. The annual numbers in each of these categories were evaluated under the hypothesis of stationary Poisson processes with mean values equal to those seen from 1975-1984.
Results:
After the exclusions, annual mortality from trauma has remained within control limits consistent with the Poisson model. Death from neurologic deterioration has shown a trend consistent with significant improvement in the process mean. Transient peaks in the other categories did not exceed control limits, but Pareto analysis prompted detailed studies of aortic and liver trauma.
Conclusions:
Process control methodology is easy to apply and potentially useful in monitoring hospital trauma mortality.
Insights
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.
- 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.
Related Concept Videos
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic illness...
01:20Comparing the Survival Analysis of Two or More Groups
01:15Introduction to Statistical Process Control