Continued rationale of why hospital mortality is not an appropriate measure of trauma outcomes.

ABSTRACT

BACKGROUND: We hypothesized that standardized withdrawal of care (WOC) practices and an aggressive long-term acute care facility (LTAC) discharge protocol could change hospital mortality and national ranking among trauma centers. STUDY DESIGN: Patients who died while admitted to the trauma service at a level 1 trauma center were classified as either an "LTAC candidate" or "not a LTAC candidate" at 4 time points before death. RESULTS: A total of 216 patients died, and 48% had WOC. Hospital mortality was 3.3%. More than 26% of these qualified as LTAC candidates. The aggressive LTAC discharge protocol reduced hospital mortality by .9%. This was sufficient to move a trauma center into a lower quartile on the National Trauma DataBank benchmark report for 2009. CONCLUSIONS: [corrected] It is possible to reduce hospital mortality and improve quality ranking with standardized WOC and LTAC discharge protocols. This highlights the importance of measuring outcomes beyond discharge.