[Interdisciplinary quality management in the treatment of severely injured patients. Validation of a QM system for the diagnostic and therapeutic process in early clinical management].
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 Essen for the presented study. The essential elements of the QMS were the establishment of (1) an adequate protocol for documentation, (2) 20 criteria for the assessment of treatment quality, (3) regular statistical analysis of treatment quality and (4) a quality circle comprising all medical specialties for data discussion. From 5/98-9/99 a cohort of 447 patients with an average injury severity score (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 assessment 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 last period) and of the duration until performance of a cranial computed tomography 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 last period). Further positive changes were the time savings in transfusion (from 35 +/- 20 to 20 +/- 4 min) and emergency operations (from 67 +/- 20 to 48 +/- 4 min) in hemorrhagic 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 severely injured patients was significantly improved by implementation of a multidisciplinary quality management system especially with respect to treatment efficiency.
Ruchholtz
S
S
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinkum Essen, Hufelandstrasse 55, 47145 Essen. Steffen.Ruchholtz@uni-essen.de
Waydhas
C
C
Aufmkolk
M
M
Täger
G
G
Piepenbrink
K
K
Stolke
D
D
Nast-Kolb
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D019091:Critical Pathways; D004282:Documentation / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D005858:Germany; D006284:Health Plan Implementation; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008332:Management Quality Circles; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery*; D010348:Patient Care Team; D016019:Survival Analysis; D013996:Time and Motion Studies; D017749:Total Quality Management; D014193:Trauma Centers