Trauma Center Quality Improvement Programs in the United States, Canada, and Australasia

Objective: To compare quality improvement (QI) programs of trauma centers in 4 high-income countries. Background: Injury is a leading cause of morbidity and mortality in countries around the world, but patient outcomes vary among countries with similar systems of trauma care. Methods: We surveyed medical directors and program managers from 330 trauma centers verified by professional trauma organizations in the United States (n = 263), Canada (n = 46), and Australasia (Australia, n = 18; New Zealand, n = 3) regarding their QI programs. Quality indicators were requested from all centers that measured quality of care. Follow-up interviews were performed with 75 centers purposively sampled across 6 baseline criteria. Results: A total of 251 centers (76% response rate) responded to the survey, with a similar distribution across countries. Trauma centers in the United States were more likely than those in Canada and Australasia to report measuring quality indicators (100% vs 94% vs 93%, P = 0.008), using report cards (53% vs 33% vs 31%, P = 0.033) and benchmarking (81% vs 61% vs 69%, P = 0.019). Centers in all 3 regions primarily used hospital process and outcome measures designed to establish whether care was safe (98% vs 97% vs 75%, P = 0.008), effective (97% vs 97% vs 92% P = 0.399), timely (88% vs 100% vs 92%, P = 0.055), and efficient (95% vs 100% vs 83%, P = 0.082). QI programs were largely local in nature, used different criteria to identify patients under QI purview, and employed diverse quality indicators and improvement strategies. Few centers evaluated the effectiveness of their QI program. Conclusions: This study provides the first international comparison of trauma center QI programs and demonstrates broad implementation in verified trauma centers in the United States, Canada, and Australasia. Significant variation exists in how trauma centers perform QI activities. Opportunities exist for improving and standardizing QI processes.

[1]  Sharon E Straus,et al.  Evidence for quality indicators to evaluate adult trauma care: A systematic review* , 2011, Critical care medicine.

[2]  Sharon E Straus,et al.  A systematic review of quality indicators for evaluating pediatric trauma care , 2010, Critical care medicine.

[3]  S. Straus,et al.  Quality indicators for evaluating trauma care: a scoping review. , 2010, Archives of surgery.

[4]  M. Pasquale,et al.  The Trauma Quality Improvement Program: pilot study and initial demonstration of feasibility. , 2010, The Journal of trauma.

[5]  C. Mock.  WHO releases Guidelines for trauma quality improvement programmes , 2009, Injury Prevention.

[6]  C. Mock,et al.  Establishing the Evidence Base for Trauma Quality Improvement: A Collaborative WHO-IATSIC Review , 2009, World Journal of Surgery.

[7]  M. Meade,et al.  A guide for the design and conduct of self-administered surveys of clinicians , 2008, Canadian Medical Association Journal.

[8]  R. Maier,et al.  Patterns of Errors Contributing to Trauma Mortality: Lessons Learned From 2594 Deaths , 2006, Annals of surgery.

[9]  D. Bates,et al.  The “To Err is Human” report and the patient safety literature , 2006, Quality and Safety in Health Care.

[10]  Daniel O Scharfstein,et al.  A national evaluation of the effect of trauma-center care on mortality. , 2006, The New England journal of medicine.

[11]  C. Mock,et al.  Strengthening trauma systems globally: the Essential Trauma Care Project. , 2005, The Journal of trauma.

[12]  Donald M. Berwick,et al.  Connections Between Quality Measurement and Improvement , 2003, Medical care.

[13]  F P Rivara,et al.  The effect of organized systems of trauma care on motor vehicle crash mortality. , 2000, JAMA.

[14]  Wright Je.  The history of surgical audit. , 1995 .

[15]  R. Rutledge,et al.  American College of Surgeons trauma quality indicators: an analysis of outcome in a statewide trauma registry. , 1993, The Journal of trauma.

[16]  D. Dillman.  Mail and telephone surveys : the total design method , 1979 .

[17]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[18]  J. Arnold,et al.  International emergency medicine and the recent development of emergency medicine worldwide. , 1999, Annals of emergency medicine.

[19]  J. Wright.  The history of surgical audit. , 1995, Journal of quality in clinical practice.

[20]  T R Miller,et al.  DATABOOK ON NONFATAL INJURY: INCIDENCE, COSTS, AND CONSEQUENCES , 1995 .

[21]  A. Lalonde.  Canadian Institute for Health Information. , 1994, Canadian journal of medical technology.

[22]  D. Dillman,et al.  Mail and telephone surveys , 1978 .