Quality management of early clinical treatment of severely injured patients

Abstract

The early clinical treatment of severely injured patients of today is based on modern technical resources as well as on refined therapeutic strategies involving a multidisciplinary team. In the meantime the requirements for and expectations towards best major trauma care have both increased considerably. In spite of a decline in mortality after major trauma during the last two decades still clinical deviations from actual treatment guidelines with proven influence on negative outcome are to be found. In order to improve the therapeutic process it proved effective to introduce the main principles of quality assurance (QA) and quality management (QM) that were used successfully in industry into major trauma treatment. In QA an analysis of 'process', 'structure' and 'outcome' of the clinical treatment is performed. For these components of QA important tools such as treatment-guidelines (polytrauma-algorithms), guidelines by the German Society of Trauma Surgery for the equipment of a trauma center and score systems for the classification of injury severity were elaborated and implemented in major trauma care. Further optimization of outcome quality may be achieved by integrating the QA- components in a QM-system. QM means introducing relevant feed-back-pathways of procedural data for the improvement of the (treatment-) process and of outcome data for decisions about structural (and organizational) changements. The presented clinical QM-system is based on adequate documentation, analysis and assessment of treatment data within a quality committee. The treatment of severely injured patients was significantly improved by implementation of the QM-system in clinical routine with respect to the effectivity of the treatment process. Furthermore, by transferring the QM-system to another trauma center, we were able to show that the effects of the system in major trauma care are reproducible. Besides the internal efforts for quality optimization an external quality assessment comparing the own treatment results with other trauma centers should take place. For this purpose joining a multicentered trauma registry (i.e. the trauma registry of the German Society of Trauma Surgery for the German speaking countries) is recommended.