Setting standards and implementing quality improvement in trauma care.
Setting standards and implementing quality improvement in trauma care needs consideration of the definitions of standards, guidelines, recommendations and the present quality of trauma care. Essential factors for consideration are the chain of survival and different intervals which may decide on patient outcome: (a) the trauma (occurrence) to trauma recognition interval which has, until now, not been taken into consideration with regard to morbidity and mortality; (b) the scene time is part of the total prehospital time which comprises rescuing the entrapped patient, preparation of the patient for treatment, and transfer to a rescue vehicle. The medical part of the scene time, however, represents only 25% of the total scene time and an even lower percentage of the total prehospital time. Correlating scene time with outcome and concluding that medical treatment at the scene may be detrimental to the patient are thus inaccurate suppositions. It has been shown that the quality of care is not always based on scientific evidence. This is the case for fluid administration, endotracheal intubation, etc. Furthermore, the qualification of the different personnel responding to trauma alert needs to be taken into consideration as well as the quality of care provided by the individual hospitals. The following conclusions may thus be drawn: that, currently there is no scientifically proven standard or care for trauma patients; the role of trauma care standards in the reduction of mortality and morbidity has not yet been identified; implementing incorrect standards may lead to entirely inappropriate conclusions; and that it is essential to perform scientific investigations of the outlined factors in order to establish future standards of trauma care.
Dick
W F
WF
Clinic of Anaesthesiology, Johannes Gutenberg University Hospital, Mainz, Germany.
D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D017408:Guidelines as Topic; D006801:Humans; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D011787:Quality of Health Care; D015996:Survival Rate; D013996:Time and Motion Studies; D014193:Trauma Centers