Trauma emergency unit: long-term evaluation of a quality assurance programme.
OBJECTIVE
Long-term evaluation of a quality assurance programme (after an assessment in 1993).


METHODS
Review of medical records.


METHODS
Emergency area of an orthopaedic, trauma, and plastic surgery unit in a French teaching hospital (Besancon).


METHODS
1187 consecutive ambulatory patients' records, from July 1995.


METHODS
Occurrence of near adverse events (at risk events causing situations which could lead to the occurrence of an adverse event).


RESULTS
71 near adverse events were identified (5.9% of the ambulatory visits). There was a significant decrease in the rate of near adverse events between 1993 (9.9% (2056 ambulatory visits, 204 near adverse events)), and 1995 (5.9% (1187 ambulatory visits, 71 near adverse events)), and significant change in the proportion of each category of adverse event (decrease in departures from prevention protocols).


CONCLUSIONS
Despite their limitations, the effectiveness and efficiency of quality assurance programmes seem to be real and valuable. Maintaining quality improvement requires conditions which include some of the basic principles of total quality management (leadership, participatory management, openness, continuous feed back). The organisation of this unit as a specialised trauma centre was also a determining factor in the feasibility of a quality assurance programme (specialisation and small size, high activity volume, management of the complete care process). Quality assurance is an important initial step towards quality improvement, that should precede consideration of a total quality management programme.
Gagneux
E
E
Hôpital Jean Minjoz, Besancon Cedex, France.
Lombrail
P
P
Vichard
P
P
D005602:France; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching / Q000458:organization & administration / Q000592:standards; D008485:Medical Audit; D015397:Program Evaluation; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000191:economics / Q000458:organization & administration*; D014193:Trauma Centers / Q000592:standards*