QUALITY MANAGEMENT IN THE EARLY TREATMENT OF PATIENTS WITH MULTIPLE INJURIES .2. QUALITY IMPROVEMENT GUIDELINES

To enhance the quality of treatment of patients with multiple injuries (blunt trauma), guidelines for the acute clinical management (trauma- algorithm) were implemented at our clinic in 1994. The impact of these guidelines was analysed, comparing two prospectively recorded collect ives of polytraumatized patients 4/1988-12/1993 (A; n = 126)and 1/1994 -6/1996 (B; n = 74). Nine specifically defined parameters were used to assess the therapeutic process of early clinical trauma management. A ll parameters showed an improvement after implementation of the algori thm (group B): (1) Complete radiological and sonographic basic diagnos tics in 97 % vs. 92 % of patients; (2) time interval of 38 min vs. 55 min until cranial CT was done after severe head injury (GCS < 10); (3) reduction of delayed diagnosis of lesions to 5 % vs. 24 %; (4) durati on of 16 min vs. 20 min until intubation; (5) period of 23 min to 30 m in to pleural drainage; (6) duration of 18 min vs. 32 min until transf usion in shock; (7) period of 79 min vs. 98 min until emergency operat ion in shock; (8) duration of 95 min vs. 124 min until trepanation, an d (9) operation rate within 24 h after admission to ICU in 3 % vs. 12 %. The lethality rates of each collective were assessed after subdivis ion in three groups (I-III) with middle (ISS: 18-24), high (ISS: 25-49 ) and extreme (ISS: 50-75) injury severity. In all groups of both coll ectives ISS values, age, initial loss of consciousness (GCS) and shack were comparable (except the higher injury severity of collective B in group I). In all groups a reduction of lethality could be shown for c ollective B: Group I, 0 % vs. 20 % (P < 0.05); group II, 8 % vs. 24 % (P < 0.05); and group III, 40 % vs. 71 %, not significant because of t he small group in B (n = 5). The implementation of therapeutic managem ent guidelines led to an improvement of both treatment processes and o utcome. In order to regularly reassess validity and practicability of such guidelines as well as further enhance therapeutic quality, a cont inuous evaluation programme representing a quality management system s hould be inaugurated.