Improving performance in the management of severely injured patients in critical care.
OBJECTIVE
To determine opportunities for improvement (OI) in the critical care management of severely injured patients in a general adult intensive care unit through a performance improvement (PI) process.


METHODS
Retrospective review of patient records from intensive care patients who had sustained traumatic injuries, except isolated head injury, over a 1-year period. Three assessors independently audited the notes using performance improvement methodology to determine complications, errors in management and preventability. Complications were included when two or more assessors independently detected the complication.


RESULTS
Records from 90 patients with a diagnosis of 'trauma' were reviewed, 14 patients with isolated head injury were excluded. The mean injury severity score was 23 (range 4-43). No complications or errors of management were identified from 41 patients, including ten patients who died. Seventy-two complications were identified in 35 patients including 15 pneumonias, 6 cases of peri-operative hypothermia and 5 recurrent pneumothoraces. Fourteen preventable complications were identified.


CONCLUSIONS
The PI OI process highlighted specific opportunities for the improvement of critical care management of trauma patients in our unit. These will be addressed through the introduction of formal tertiary surveys and clinical management guidelines addressing hypothermia and management of coagulopathy.
Brooks
Adam J
AJ
Department of Surgery, Queen's Medical Centre, Nottingham, UK.
Sperry
Dave
D
Riley
Bernard
B
Girling
Keith J
KJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000592:standards*; D004739:England; D005260:Female; D006302:Health Services Research; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008485:Medical Audit; D019300:Medical Errors / Q000517:prevention & control; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*