Establishing the evidence base for trauma quality improvement: a collaborative WHO-IATSIC review.
BACKGROUND
Quality improvement (QI) programs are an integral part of well-developed trauma systems. However, they have not been extensively implemented globally. To promote greater use of effective QI programs, the World Health Organization (WHO) and the International Association for Trauma Surgery and Intensive Care (IATSIC) have been collaboratively developing the upcoming Guidelines for Trauma Quality Improvement Programmes. As part of the development of this publication and to satisfy global demands for WHO guidelines to be evidence based, we conducted a thorough literature search on the effectiveness of trauma QI programs.


METHODS
The review was based on a PubMed search of all articles reporting an outcome from a trauma QI program.


RESULTS
Thirty-six articles were identified that reported results of evaluations of a trauma QI program or in which the trauma QI program was integrally related to identification and correction of specific problems. Thirteen of these articles reported on mortality as their main outcome; 12 reported on changes in morbidity (infection rates, complications), patient satisfaction, costs, or other outcomes of tangible patient benefit; and 11 reported on changes in process of care. Thirty articles addressed hospital-based care; four system-wide care; and two prehospital care. Thirty-four articles reported an improvement in the outcome assessed; two reported no change; and none reported worsening of the outcome. Five articles also reported cost savings.


CONCLUSIONS
Trauma QI programs are consistently shown to improve the process of care, decrease mortality, and decrease costs. Further efforts to promote trauma QI globally are warranted. These findings support the further development and promulgation of the WHO-IATSIC Guidelines for Trauma QI Programmes.
Juillard
Catherine J
CJ
Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
Mock
Charles
C
Goosen
Jacques
J
Joshipura
Manjul
M
Civil
Ian
I
D019317:Evidence-Based Medicine; D014943:Global Health; D006801:Humans; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D014194:Traumatology / Q000458:organization & administration* / Q000592:standards*; D014944:World Health Organization