S. Ruchholtz et al., A multidisciplinary quality management system (QMS) for the early treatment of severely injured patients in a trauma center in Germany, UNFALLCHIRU, 104(10), 2001, pp. 927
A multidisciplinary quality management system (QMS) for the early treatment
of severely injured patients was validated in a trauma center in Germany.
In the presented prospective study a QMS developed at another trauma center
was implemented at the department of trauma surgery of the university of E
ssen for the presented study. The essential elements of the QMS were the es
tablishment of (1) an adequate protocol for documentation, (2) 20 criteria
for the assessment of treatment quality, (3) regular statistical analysis o
f treatment quality and (4) a quality circle comprising all medical special
ties for data discussion.
From 5/98-9/99 a cohort of 447 patients with an average injury severity sco
re (ISS) of 22+/-17 was treated in the emergency department. The impact of
the QMS was assessed in 4 periods (1: 5/1998-8/1998;2:9-12/1998; 3:1-4/1999
; 4: 5-8/1999). The quality circle met 8 times. For the improvement of the
process 16 long-term changes were introduced. In 60% (n=12) of the 20 asses
sment criteria significant improvements were detected. In diagnostics there
were significant reductions of the time needed for basic radiological and
sonographic check-up (from 24+/-12 min in the first to 14+/-8 min in the la
st period) and of the duration until performance of a cranial computed tomo
graphy in severe traumatic brain injury (sTBI; from 45+/-22 to 28+/-8 min).
The rate of delayed diagnoses remained low (4% in the first, 5% in the las
t period). Further positive changes were the time savings in transfusion (f
rom 35+/-20 to 20+/-4 min) and emergency operations (from 67+/-20 to 48+/-4
min) in hemorraghic shock as well as for craniotomies (77+/-41 to 54+/-19
min) in sTBI. Apart from the significant time reductions other improvements
were found. Overall mortality was diminished from 17% in the first to 10%
in the last observation period.
In conclusion the study revealed that the quality of the early therapy of s
everely inured patients was significantly improved by implementation of a m
ultidisciplinary quality management system especially with respect to treat
ment efficiency.