The authors examined the association between the size of an emergency department (ED), volume inc... more The authors examined the association between the size of an emergency department (ED), volume increases over time, length of stay (LOS), and left before treatment complete (LBTC). EDs participating in the Emergency Department Benchmarking Alliance providing at least two years of data from 2004 to 2011 were included in the analysis. The impact of volume on LOS and LBTC varied depending on annual ED volume. Based on this, EDs can anticipate better how changes in volume will impact patient throughput in the future.
Journal of Trauma-injury Infection and Critical Care - J TRAUMA, 1989
The Z statistic can be used to test whether the observed number of survivors in a specific trauma... more The Z statistic can be used to test whether the observed number of survivors in a specific trauma population is significantly different from what would be expected based on the Major Trauma Outcome Study (MTOS) norms. However, as with any statistic, inferences based on the Z statistic should be made with care. This is particularly true when a non-significant Z statistic is observed. The purpose of this paper, using data from a large, urban trauma registry, is to illustrate how the power of the Z statistic, or its ability to detect a difference between observed and expected survival, is influenced by the magnitude of the difference, the direction of the difference, the survival probability distribution of the study population, and the sample size. The implications for trauma research and quality assurance review are discussed.
The Journal of Trauma: Injury, Infection, and Critical Care, 1988
It has been suggested that if triage criteria are to identify accurately patients with major trau... more It has been suggested that if triage criteria are to identify accurately patients with major trauma, not only physiologic status, but also anatomic site and injury mechanism must be assessed. This study examined the influence of physiologic, injury site, and injury mechanism criteria on the diagnosis of major trauma in 2,057 trauma patients. Because the Trauma Score was found to be a highly specific indicator of major trauma (98.7%), the strategy adopted for isolating the factors that minimize inappropriate triage was to determine which, alone or in combination, are the most effective in identifying patients with major trauma among those with high Trauma Scores (greater than 12). Based on this analysis, a set of triage guidelines was developed. The application of these guidelines to the study population indicated an undertriage rate of 4.1 to 6.3% and an overtriage rate of 16.8 to 21.3%, depending on the definition of major trauma.
JAMA: The Journal of the American Medical Association, 1987
... other west African countries (Burkina Faso, Gambia, Liberia, Mali, Maureta-nia, Niger, Senega... more ... other west African countries (Burkina Faso, Gambia, Liberia, Mali, Maureta-nia, Niger, Senegal, and Sierra Leone) has not shown a significant increase in documented cases of ... As shown by Baxt and Moody, MDs may also have difficulty with field management of the airway. ...
As the Centers for Medicare &... more As the Centers for Medicare & Medicaid Services (CMS) core measures in 2013 compare Emergency Department (ED) treatment time intervals, it is important to identify ED and hospital characteristics associated with these metrics to facilitate accurate comparisons. The objective of this study is to assess differences in operational metrics by ED and hospital characteristics. ED-level characteristics included annual ED volume, percentage of patients admitted, percentage of patients presenting by ambulance, and percentage of pediatric patients. Hospital-level characteristics included teaching hospital status, trauma center status, hospital ownership (nonprofit or for-profit), inpatient bed capacity, critical access status, inpatient bed occupancy, and rural vs. urban location area. Data from the ED Benchmarking Alliance from 2004 to 2009 were merged with the American Hospital Association's Annual Survey Database to include hospital characteristics that may impact ED throughput. Overall median length of stay (LOS) and left before treatment is complete (LBTC) were the primary outcome variables, and a linear mixed model was used to assess the association between outcome variables and ED and hospital characteristics, while accounting for correlations among multiple observations within each hospital. All data were at the hospital level on a yearly basis. There were 445 EDs included in the analysis, from 2004 to 2009, with 850 observations over 6 years. Higher-volume EDs were associated with higher rates of LBTC and LOS. For-profit hospitals had lower LBTC and LOS. Higher inpatient bed occupancies were associated with a higher LOS. Increasing admission percentages were positively associated with overall LOS for EDs, but not with rates of LBTC. Higher-volume EDs are associated with higher LBTC and LOS, and for-profit hospitals appear more favorably in these metrics compared with their nonprofit counterparts. It is important to appreciate that hospitals have different baselines for performance that may be more tied to volume and capacity, and less to quality of care.
The authors examined the association between the size of an emergency department (ED), volume inc... more The authors examined the association between the size of an emergency department (ED), volume increases over time, length of stay (LOS), and left before treatment complete (LBTC). EDs participating in the Emergency Department Benchmarking Alliance providing at least two years of data from 2004 to 2011 were included in the analysis. The impact of volume on LOS and LBTC varied depending on annual ED volume. Based on this, EDs can anticipate better how changes in volume will impact patient throughput in the future.
Journal of Trauma-injury Infection and Critical Care - J TRAUMA, 1989
The Z statistic can be used to test whether the observed number of survivors in a specific trauma... more The Z statistic can be used to test whether the observed number of survivors in a specific trauma population is significantly different from what would be expected based on the Major Trauma Outcome Study (MTOS) norms. However, as with any statistic, inferences based on the Z statistic should be made with care. This is particularly true when a non-significant Z statistic is observed. The purpose of this paper, using data from a large, urban trauma registry, is to illustrate how the power of the Z statistic, or its ability to detect a difference between observed and expected survival, is influenced by the magnitude of the difference, the direction of the difference, the survival probability distribution of the study population, and the sample size. The implications for trauma research and quality assurance review are discussed.
The Journal of Trauma: Injury, Infection, and Critical Care, 1988
It has been suggested that if triage criteria are to identify accurately patients with major trau... more It has been suggested that if triage criteria are to identify accurately patients with major trauma, not only physiologic status, but also anatomic site and injury mechanism must be assessed. This study examined the influence of physiologic, injury site, and injury mechanism criteria on the diagnosis of major trauma in 2,057 trauma patients. Because the Trauma Score was found to be a highly specific indicator of major trauma (98.7%), the strategy adopted for isolating the factors that minimize inappropriate triage was to determine which, alone or in combination, are the most effective in identifying patients with major trauma among those with high Trauma Scores (greater than 12). Based on this analysis, a set of triage guidelines was developed. The application of these guidelines to the study population indicated an undertriage rate of 4.1 to 6.3% and an overtriage rate of 16.8 to 21.3%, depending on the definition of major trauma.
JAMA: The Journal of the American Medical Association, 1987
... other west African countries (Burkina Faso, Gambia, Liberia, Mali, Maureta-nia, Niger, Senega... more ... other west African countries (Burkina Faso, Gambia, Liberia, Mali, Maureta-nia, Niger, Senegal, and Sierra Leone) has not shown a significant increase in documented cases of ... As shown by Baxt and Moody, MDs may also have difficulty with field management of the airway. ...
As the Centers for Medicare &... more As the Centers for Medicare & Medicaid Services (CMS) core measures in 2013 compare Emergency Department (ED) treatment time intervals, it is important to identify ED and hospital characteristics associated with these metrics to facilitate accurate comparisons. The objective of this study is to assess differences in operational metrics by ED and hospital characteristics. ED-level characteristics included annual ED volume, percentage of patients admitted, percentage of patients presenting by ambulance, and percentage of pediatric patients. Hospital-level characteristics included teaching hospital status, trauma center status, hospital ownership (nonprofit or for-profit), inpatient bed capacity, critical access status, inpatient bed occupancy, and rural vs. urban location area. Data from the ED Benchmarking Alliance from 2004 to 2009 were merged with the American Hospital Association's Annual Survey Database to include hospital characteristics that may impact ED throughput. Overall median length of stay (LOS) and left before treatment is complete (LBTC) were the primary outcome variables, and a linear mixed model was used to assess the association between outcome variables and ED and hospital characteristics, while accounting for correlations among multiple observations within each hospital. All data were at the hospital level on a yearly basis. There were 445 EDs included in the analysis, from 2004 to 2009, with 850 observations over 6 years. Higher-volume EDs were associated with higher rates of LBTC and LOS. For-profit hospitals had lower LBTC and LOS. Higher inpatient bed occupancies were associated with a higher LOS. Increasing admission percentages were positively associated with overall LOS for EDs, but not with rates of LBTC. Higher-volume EDs are associated with higher LBTC and LOS, and for-profit hospitals appear more favorably in these metrics compared with their nonprofit counterparts. It is important to appreciate that hospitals have different baselines for performance that may be more tied to volume and capacity, and less to quality of care.
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Papers by Charles Shufflebarger