Study sheds new light on the importance of implementing best practices in hospitals

New research from the Baylor Institute for Health Care Research and Improvement showed that a hospital's commitment to implementing best practices significantly improves the quality of care it provides its patients. The study's findings, which were e-published in the Journal of the American College of Surgeons, sheds new light on the life-or-death importance of following best practices.

Led by Shahid Shafi, MD, MPH, FACS, a team of nationally renowned investigators conducted a study named "Compliance with Recommended Care at Trauma Centers and its Association with Patient Outcomes." The researchers sought to determine whether certain top-tier trauma centers (Baylor's included) were following a set of 22 commonly recommended practices as a measure of quality of care.

The study included five Level 1 trauma centers across the country, and while those centers varied in geography, urban/rural areas and ethnic and socioeconomic populations, investigators found one stark similarity among them: Compliance with best practices improved the outcomes of patients with major injuries.

In fact, every 10 percent increase in compliance was associated with a 14 percent reduction in the risk of death. But troublingly, the study found, not all trauma centers follow all the recommended procedures, resulting in compliance gaps to the tune of one severe statistic: Nearly one in four patients received less than half of the recommended care.

The "recommended care" included 22 evidence-based, expert-recommended approaches to diagnosis and treatment of major injuries, ranging from the administration of CT scans to antibiotics distribution. Investigators measured the hospitals' compliance to those approaches and found that it ranged from as little as 12 percent to as high as 94 percent on certain clinical practices.

"Until recently, medical research has primarily focused on finding new and better ways to treat patients," said Dr. Shafi, who has spent the past 10 years of his career on research related to measuring quality-of-care. "However, there has not been enough emphasis on 'knowledge translation.' That is the application of science to routine clinical practices. The findings of this study show that we need to put more effort into ensuring that our patients receive the best possible care, in a timely fashion."

San Antonio-based National Trauma Institute funded the study with support from the US Department of Defense (DoD). In research involving care of the injured, Dr. Shafi said, it is common for the DoD to supply funding as it has a direct impact on military personnel. This study's results, he added, could open new doors to support future extensions of the work.

"The findings of this study have led to another grant proposal that has been submitted to the Agency for Healthcare Research and Quality as well as the US Department of Defense to incorporate evidence-based recommendations into routine clinical practices at trauma centers," he said.