QUALITY MANAGEMENT IN THE EARLY CARE OF P ATIENTS WITH MULTIPLE INJURIES - DOCUMENTATION OF TREATMENT AND REVIEW OF QUALITY OF CARE

Quality management in early clinical care of patients with multiple in juries (description of actual process, identification of problems, imp lementation of quality improvement) is not possible without sufficient baseline data about the present situation of medical treatment. This study investigates whether the current documentation of treatment in t he emergency room is appropriate to judge upon the quality of the proc ess and to detect problems. In addition, a set of baseline data is pre sented. The performance in the treatment of 126 multiple injured patie nts was prospectively recorded from 1988 to 1993 and com pa red with a n idealized process based upon an algorithm. The quality of present da ta recording was analysed, and criteria for judgement of quality of ca re were assessed. The algorithm was devided into 117 possible steps (o ne step consisting of a single decision criterion, the decision and th e corresponding procedure). Per patient, only 61% +/- 12% of these ste ps were sufficiently documented to allow judgement. Using several crit eria for assessment, the following baseline data could be observed (ti mes shown refer to admission to the trauma room): (1)trauma room time of 129 +/- 55 min; (2) completition of basic radiological and sonograp hic diagnostics in 91% of patients; (3) first blood collection after 1 7 +/- 11 min; (4) cranial computerised tomography after 55 +/- 20 min; (5) missed injuries during the trauma room period in 32% of patients; (6) intubation after 20 +/- 19 min; (7) insertion of a chest tube aft er 30 +/- 17 min; (8) first blood transfusion in shock after 32 +/- 17 min; (9) transfused blood within the first hour of 4.2 +/- 2.8 units and within the second hour of 8.5 +/- 4.7 units; (10) emergency operat ions in shock after 98 +/- 55 min; (11) early operations after 156 +/- 69 min; (12) craniotomy after 124 +/- 37 min; (13) unplanned surgery within 24 hours after admission to the intensive care unit in 11% of p atients. The study presented here supplies information on timing and o ther process data of the acute clinical care of seriously injured pati ents. In particular, the data represent indicators for the quality of emergency room management, which may be used as a baseline to compose improvement measures of structure and process. The quality of data col lection has to be improved for carrying out an exact analysis of the p rocess.