The effect of a quality improvement program on paramedic on-scene times for patients with penetrating trauma.
OBJECTIVE
To decrease paramedic on-scene times (OSTs) for major trauma patients through a focused quality improvement (QI) program.


METHODS
A prospective study was conducted from 1993 through 1997 to determine the impact of a QI program on paramedic OSTs. All penetrating trauma patients transported by paramedics to Los Angeles County/USC Medical Center, a Level-1 trauma center, were included, and all cases with OSTs > 20 minutes were reviewed in detail for extenuating circumstances. Cases including multiple victims or unsecured scenes were considered "acceptable deviations." All others were considered "fallouts," which prompted extensive review with the paramedics and their field supervisors.


RESULTS
Prior to the inception of the QI project there was a 4.1% fallout rate of penetrating trauma patients with OSTs > 20 minutes. This fallout rate fell to 1.5% in 1997 (p < 0.01). Mortality rates among these fallouts decreased from 5.1% to 0.8% during the study period (p < 0.01).


CONCLUSIONS
An intensive QI program can have a significant, positive impact on paramedic OSTs among patients with penetrating trauma.
Eckstein
M
M
University of Southern California School of Medicine and the Los Angeles City Fire Department, USA. eckstein@hsc.usc.edu
Alo
K
K
D004632:Emergency Medical Services / Q000592:standards* / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D015601:Injury Severity Score; D015141:Los Angeles; D011785:Quality Assurance, Health Care; D013997:Time Factors; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data; D014950:Wounds, Penetrating / Q000145:classification / Q000401:mortality / Q000628:therapy*