A multidisciplinary quality management system for the early treatment of severely injured patients: implementation and results in two trauma centers.
OBJECTIVE
The impact of a multidisciplinary quality management system (MQMS) on the early treatment of severely injured patients was tested.


METHODS
Prospective clinical study in two level 1 trauma centers.


METHODS
MQMS comprised a protocol for documentation, 20 assessment criteria, and the judgement of data by a quality circle. After implementation in Munich (1st period, n=90; 2nd period, n=77) the validation took place in Essen (1st period, n=175; 2nd period, n=150).


RESULTS
Improvements in diagnostics were shown by significant time savings in radiological diagnostics and before computed tomography in severe traumatic brain injury. In patients with hemorrhagic shock there was a reduction in time before transfusion (49 to 14 min in Munich; 31 to 22 min in Essen) and before emergency operation (74 to 43 min in Munich; 69 to 45 min in Essen). The time before craniotomy was reduced from 97 to 67 min in Munich. The incidence of delayed diagnosis of life-threatening lesions was diminished from 6% to 3% in Munich (not found in Essen). The TRISS technique showed a reduction in mortality in both hospitals in the second period (Munich: 15.4% TRISS vs. 9.1% observed mortality; Essen: 17.8% vs. 11.3%).


CONCLUSIONS
MQMS improved early clinical treatment in severe injury with respect to therapeutic effectiveness and outcome. The effectiveness of the MQMS was shown at two different hospitals
Ruchholtz
Steffen
S
Department of Trauma Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany. steffen.ruchholtz@uni-essen.de
Waydhas
Christian
C
Lewan
Ulrike
U
Piepenbrink
Karl
K
Stolke
Dietmar
D
Debatin
Jörg
J
Schweiberer
Leonhard
L
Nast-Kolb
Dieter
D
D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D033183:Interdisciplinary Communication; D008332:Management Quality Circles; D009104:Multiple Trauma / Q000628:therapy; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D013997:Time Factors; D017749:Total Quality Management; D014193:Trauma Centers / Q000458:organization & administration / Q000592:standards*; D014947:Wounds and Injuries / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000628:therapy; D014950:Wounds, Penetrating / Q000628:therapy