Education, exposure and experience of prehospital teams as quality indicators in regional trauma systems.

Abstract

Indicators to measure the quality of trauma care may be instrumental in benchmarking and improving trauma systems. This retrospective, observational study investigated whether data on three indicators for competencies of Dutch trauma teams (i.e. education, exposure, experience; agreed upon during a prior Delphi procedure) can be retrieved from existing registrations. The validity and distinctive power of these indicators were explored by analysing available data in four regions. Data of all polytrauma patients treated by the Helicopter Emergency Medical Services were collected retrospectively over a 1-year period. During the Delphi procedure, a polytrauma patient was defined as one with a Glasgow Coma Scale of 9 or less or a Paediatric Coma Scale of 9 or less, together with a Revised Trauma Score of 10 or less. Information on education, exposure and experience of the Helicopter Emergency Medical Services physician and nurse were registered for each patient contact. Data on 442 polytrauma patients could be retrieved. Of these, according to the Delphi consensus, 220 were treated by a fully competent team (i.e. both the physician and the nurse fulfilled the three indicators for competency) and 22 patients were treated by a team not fulfilling all three indicators for competency. Across the four regions, patients were treated by teams with significant differences in competencies (P=0.002). The quality indicators of education, exposure and experience of prehospital physicians and nurses can be measured reliably, have a high level of usability and have distinctive power.