Introduction: Reproducible metrics are needed to evaluate the delivery of orthopaedic trauma care, national care, norms, and outliers. The American College of Surgeons (ACS) is uniquely positioned to collect and evaluate the data needed to evaluate orthopaedic trauma care via the Committee on Trauma and the Trauma Quality Improvement Project.
Methods: We evaluated the first quality metrics the ACS has collected for orthopaedic trauma surgery to determine whether these metrics can be appropriately collected with accuracy and completeness. The metrics include the time to administration of the first dose of antibiotics for open fractures, the time to surgical irrigation and débridement of open tibial fractures, and the percentage of patients who undergo stabilization of femoral fractures at trauma centers nationwide. These metrics were analyzed to evaluate for variances in the delivery of orthopaedic care across the country.
Results: The data showed wide variances for all metrics, and many centers had incomplete ability to collect the orthopaedic trauma care metrics. There was a large variability in the results of the metrics collected among different trauma center levels, as well as among centers of a particular level.
Discussion: The ACS has successfully begun tracking orthopaedic trauma care performance measures, which will help inform reevaluation of the goals and continued work on data collection and improvement of patient care. Future areas of research may link these performance measures with patient outcomes, such as long-term tracking, to assess nonunion and function. This information can provide insight into center performance and its effect on patient outcomes.
Conclusions: The ACS was able to successfully collect and evaluate the data for three metrics used to assess the quality of orthopaedic trauma care. However, additional research is needed to determine whether these metrics are suitable for evaluating orthopaedic trauma care and cutoff values for each metric.
From the Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO (Dr. Miller), the Center for Translational Medicine, Shock Trauma Center, and Shock, Trauma, and Anesthesiology Research (STAR) Center, University of Maryland, Baltimore, MD (Dr. Kozar), and the Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA (Dr. Wolinsky).
Correspondence to Dr. Miller: anmiller@gmail.com
Dr. Miller or an immediate family member has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from AO North America and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the American College of Surgeons, AOTrauma North America, and the Orthopaedic Trauma Association. Dr. Wolinsky or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of and serves as a paid consultant to Zimmer Biomet; has received research or institutional support from DePuy Synthes; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the American College of Surgeons, the American Orthopaedic Association, and the Orthopaedic Trauma Association. Neither Dr. Kozar nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.
Received July 05, 2016
Accepted December 24, 2016
