title: Trauma center volume and quality improvement programs.
abstract: BACKGROUND
  Growing evidence suggests that for many treatments, a relationship exists between provider volume and patient outcomes. This relationship is less clear in injury management. We sought to evaluate whether a relationship exists between trauma center volume and the nature of quality improvement (QI) programs.
  
  
  METHODS
  This is a survey of 154 verified adult trauma centers in the United States, Canada, Australia, and New Zealand (76% response rate) regarding their QI programs. Centers were classified according to American College of Surgeons annual volume requirements for a Level I center (low volume vs. high volume) and QI programs compared.
  
  
  RESULTS
  All participating trauma centers reported using a trauma registry and measuring quality of care. Low-volume centers were more likely than high-volume centers to use quality indicators for evaluating triage and patient flow (18% vs. 13%, p < 0.001), effectiveness of care (33% vs. 30%, p = 0.016), and efficiency of care (29% vs. 23%, p < 0.001). High-volume centers were more likely to use quality indicators for evaluating medical errors and adverse events (30% vs. 36%, p < 0.001) and the use of guidelines/protocols (2% vs. 3%, p = 0.001). Report cards (41% vs. 59%, p = 0.025) and internal benchmarking (79% vs. 91%, p = 0.040) were less frequently reported to be used by low-volume than high-volume centers.
  
  
  CONCLUSIONS
  Both low- and high-volume centers reported being engaged in QI. Small differences in the types of quality indicators used by centers were observed according to volume, with high-volume centers more likely than low-volume centers to use report cards and benchmarking as QI tools.
authors.affiliation: Department of Critical Care Medicine, Institute for Public Health, University of Calgary, Calgary, Canada. tstelfox@ucalgary.ca
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.forename: Farah
authors.initials: F
authors.lastname: Khandwala
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Santana
mesh_terms: D001315:Australia; D002170:Canada; D019538:Health Care Surveys; D006801:Humans; D015601:Injury Severity Score; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement / Q000592:standards / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000592:standards / Q000706:statistics & numerical data; D011787:Quality of Health Care; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy