TRAUMA AUDIT AND QUALITY IMPROVEMENT

Audit is the evaluation of patient care. The care of the injured patie nt commences at the accident scene and involves prehospital triage and management, emergency hospital assessment and resuscitation, diagnost ic and therapeutic interventions, operative surgery, intensive care un it management, acute hospital care and rehabilitation. Audit assesses the delivery of trauma care and clinical management and through identi fication of inadequacies facilitates the introduction of appropriate i mprovements. Both the American National Academy of Sciences - National Research Council and the Australian National Health & Medical Researc h Council have recommended the establishment of an audit process to ev aluate the quality of trauma management and to obtain quality assuranc e. They have advised that this process would be assisted by the develo pment of regional trauma registries and a uniform approach to the grad ing of injuries. Reduction in the preventable death rate, frequency of complications and duration of hospitalization has followed audits as a result of changes in the organization and quality of trauma care. In the United States, for example, the preventable death rate after inju ry was reduced from 35 to 15% in Orange County, California and from 14 to 3% in San Diego County, California. Studies from Great Britain, Th e Netherlands, Canada, Australia and elsewhere have further supported the view that trauma audit modifies practice leading to reductions in mortality and morbidity.