JMIR Publications

ABSTRACT

Background:

Injury care involves the complex interaction of patient, physician, and environment that impacts patient complications, level of harm, and failure to rescue (FTR). FTR represents the likelihood of a hospital to “rescue” patients from death after in-hospital complications.

Objective:

We hypothesize that error type and number of errors contribute to increased level of harm and failure to rescue.

Methods:

Patient information was abstracted from weekly Trauma Performance Improvement (PI) (1/1/16 -7/19/17), where trauma surgeons determined level of harm and identified factors associated with complications. Level of harm was determined by definitions set forth by the Agency for Healthcare Research and Quality (AHRQ). Logistic regression was used to determine the impact of individual factors on FTR and level of harm, controlling for age, gender, Charlson score, ISS, error (in diagnosis, technique, or judgment), delay (in diagnosis or intervention), and need for operation.

Results:

2,216 trauma patients presented during the study period. 224 (10.1%) had complications reported at PI; of these, 31 patients (13.8%) had FTR. PI patients were more likely to be older (mean age 51.3, S.E. 1.58, vs. 46.4 years, S.E. 0.51, p = .008) and have higher ISS (median 22 vs. 8, p < .001). Physician-attributable errors (OR 2.82, p = .001), most commonly errors in technique, and nature of injury (OR 1.91, p = .01), were associated with higher levels of harm, while delays in diagnosis or intervention were not. Each additional factor involved increased level of harm (OR 2.09, p < .001) and nearly doubled likelihood of FTR (OR 1.95, p = .01).

Conclusions:

Physician-attributable errors in diagnosis, technique, or judgment are more strongly correlated with harm than delays in diagnosis and intervention. Increasing number of errors identified in patient care correlates with an increasing level of harm and FTR. Clinical Trial: n/a