Continuous use of standard process audit filters has limited value in an established trauma system.

Abstract

To evaluate the ability of five quality assurance/ quality improvement audit filters to identify opportunities for improvement in patient care in a mature trauma system. Retrospective analysis of prospectively collected data. Total patient population at risk and audit filter fallouts were evaluated for the following audit filters: patients with (1) Glasgow Coma Scale (GCS) score < 14 who did not receive a CT scan within 2 hours of admission; (2) subdural/ epidural hematomas who did not undergo craniotomy within 4 hours; (3) open tibial fractures who did not undergo debridement within 8 hours; (4) abdominal gunshot wounds who did not undergo laparotomy within 4 hours; and (5) all deaths where a quality assurance action was taken. The filters were used for 1 year. Mortality was compared between fallouts and nonfallouts in each category and the frequency of corrective actions for each category were determined. Corrective actions were taken in 97 of the 418 fallouts from 3,787 patients at risk. The majority (77%) of these actions were for patients in the death audit filter group. There were 343 nondeath fallouts, representing 13% of the 2,719 nondeath patients at risk. Of these, 22 corrective actions were taken, representing 6.4% of the fallouts and less than 1% of the patients at risk. The non-death process based audit filters that we evaluated in our trauma system documented adherence to care process standards but found few opportunities for quality improvement, suggesting that audit filters should be periodically evaluated and changed when their goals have been accomplished.