[External quality management in the clinical treatment of severely injured patients]

Abstract

The Trauma Registry of the German Society of Trauma Surgery represents a database for interhospital quality management in the field of treating severely injured patients. The presented study analyzes the Trauma Registry's impact on treatment quality in the participating hospitals. Since 1998 annual feedback on treatment quality was given to the hospitals of the Trauma Registry. Based on the data from 2001 (10,997 patients), 21 hospitals were studied that had provided data on more than 99 patients between 1999 and 2001. Besides anonymized assessment of quality-optimizing measures implemented in the hospitals, an analysis of the treatment process based on definite criteria (audit filter) was performed. Of the 21 hospitals, 20 could be included in the presented analysis of quality-optimizing measures. In 17 (85%) hospitals an average of 5 (range: 1-17) changes were implemented. The majority (74%) of improvement measures concerned early clinical treatment (emergency room). During the analyzed period of 1999-2001 (1422/1983/1909 patients each year), significant ( p<0.05) improvements in diagnostics (reduction in radiological/sonographic basic diagnostics from 38+/-49 to 25+/-34 min) and treatment (reduction of time until emergency operation from 56+/-67 to 35+/-25 min or until ICU admission from 162+/-67 to 140+/-82 min) could be demonstrated. At the same time a significant reduction of days of ventilation therapy from 11+/-14 to 9+/-14 was detected. The continuous feedback of the quality of the treatment process led to optimization measures in many hospitals taking part in the Trauma Registry. Furthermore, significant timesavings in the early treatment process could be shown.