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Wed Apr 1 15:27:13 BST 2009

I'm trying to determine whether our regional trauma system is producing
changes in practice.  An immediately accessible process indicator would
seem to be referring hospital turn-around time (see Natasha Richardson).
So I pulled a decade's worth of records off of our registry:
in-transferred patients with ISS>15.  After no small effort I was able
to calculate each patient's time interval at the first hospital, which I
plotted and trended.  The result is appended.

I won't try to influence opinions on the result; but before anyone
scoffs at the intervals, please note: the service area comprises 21
hospitals scattered over about 26,000 square miles.  Just under half
these hospitals are within 50 ground miles, but the rest go out as far
as 200.  Licensed bed capacity runs from 0 to 175.  EM coverage may be
one or more physicians, or an extender on the night shift.  General
surgery coverage is about fifty-fifty overall during business hours, and
changes from day to day, shift to shift.  

I've got the data wonks looking at my math and compensating for the
outliers and calculating the p values and such.  But at least the trend
line slopes in the right direction.

I'd be interested in all comments, especially if anyone is aware of even
rudimentary benchmarks for this sort of analysis.  We submit to the
NTDB; but a) our experience with its like-hospital comparisons has not
inspired confidence thus far; and b) I've zero experience asking for
custom reports, and wouldn't know where to begin.

There.  Opinions?  Suggestions?  Be gentle.

Pret Bjorn, RN
Bangor, ME USA
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Rural turn-around times