%0 Journal Article
%T The 'off-hour' effect in trauma care: a possible quality indicator with appealing characteristics
%A Stefano Di Bartolomeo
%J Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
%D 2011
%I BioMed Central
%R 10.1186/1757-7241-19-33
%X Although the importance of quality indicators (QI) is undisputed, the debate concerning their validity is incessant. A recent systematic review [1] concluded that 'there is not a common set of clearly defined, evidence-based and broadly accepted QIs for evaluating the quality of trauma care.'A recent study [2] compared the mortality of trauma patients admitted inside and outside normal working hours in a North-American trauma system. Evenings, nights, and weekends were intended as non-working hours - also referred as 'after' or 'off' hours, as opposed to 'office' or 'business' hours. The study found no difference, however previous studies that investigated the so-called 'weekend' or 'off-hour' effect in various diseases yielded inconsistent results; sometimes such a difference was found [3-8,15] and sometimes not [9-15].This commentary discusses why the evaluation of the 'off-hour' effect can also be considered a QI. Furthermore, it examines the theoretical characteristics of such a QI, with a special emphasis on its potential to overcome the usual obstacles for QIs in trauma care.QIs aim at measuring quality. The common definition of quality by the United States Institute of Medicine is 'the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge [16].' Thus, any QI should be related to a certain level of the desired health outcomes. Any person is allowed to consider an outcome as 'desired' and devise the consequent QIs. Nevertheless, there is little doubt that health-care quality ultimately aims at influencing mortality and/or morbidity. Indeed, the above mentioned two outcomes are most used QIs themselves, under the category of 'outcome indicators'' of the classic classification by Donabedian [17]. However, it has been identified that the effects of quality on mortality may be difficult to measure because of a low signal-to-noise ratio [18]. It has be
%U http://www.sjtrem.com/content/19/1/33