A multidisciplinary quality management system (QMS) for the early treatment of severely injured patients in a trauma center in Germany

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.