title: A trauma quality improvement programme associated with improved patient outcomes: 21 years of experience at an Australian Major Trauma Centre.
abstract: BACKGROUND
  Quality improvement programmes are an important part of care delivery in trauma centres. The objective was to describe the effect of a comprehensive quality improvement programme on long term patient outcome trends at a low volume major trauma centre in Australia.
  
  
  METHODS
  All patients aged 15 years and over with major trauma (Injury Severity Score>15) admitted to a single inner city major trauma centre between 1992 and 2012 were studied. The outcomes of interest were in-hospital mortality and transfer to rehabilitation. Time series analysis using integer valued autoregressive Poisson models was used to determine the reduction in adjusted monthly count data associated with the intervention period (2007-2012). Risk adjusted odds ratios for mortality over three yearly intervals was also obtained using multivariable logistic regression. Crude and risk adjusted mortality was compared before and after the implementation period.
  
  
  RESULTS
  3856 patients were analysed. Crude in-hospital mortality fell from 16% to 10% after implementation (p<0.001). The intervention period was associated with a 25% decrease in monthly mortality counts. Risk adjusted mortality remained stable from 1992 to 2006 and did not fall until the intervention period. Crude and risk adjusted transfer to in-patient rehabilitation after major trauma also declined during the intervention period.
  
  
  CONCLUSIONS
  In this low volume major trauma centre, the implementation of a comprehensive quality improvement programme was associated with a reduction in crude and risk adjusted mortality and risk adjusted discharge to rehabilitation in severely injured patients.
authors.affiliation: Royal Prince Alfred Hospital, Department of Trauma Services, Australia; Sydney Medical School, University of Sydney, Australia. Electronic address: dinh.mm@gmail.com.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dinh
authors.affiliation: Royal Prince Alfred Hospital, Emergency Department, Australia. Electronic address: kendallbein@tpg.com.au.
authors.forename: Kendall J
authors.initials: KJ
authors.lastname: Bein
authors.affiliation: Monash University, Department of Epidemiology and Preventive Medicine, Australia. Electronic address: belinda.gabbe@monash.edu.
authors.forename: Belinda J
authors.initials: BJ
authors.lastname: Gabbe
authors.affiliation: Royal Prince Alfred Hospital, Department of Trauma Services, Australia. Electronic address: chrismbyrne@hotmail.com.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Byrne
authors.affiliation: Royal Prince Alfred Hospital, Department of Trauma Services, Australia. Electronic address: jfpetchell@aapt.net.au.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Petchell
authors.affiliation: Sydney Medical School, University of Sydney, Australia; The George Institute for Global Health, Injury Division, Australia. Electronic address: slo@georgeinstitute.org.
authors.forename: Serigne
authors.initials: S
authors.lastname: Lo
authors.affiliation: Sydney Medical School, University of Sydney, Australia; The George Institute for Global Health, Injury Division, Australia. Electronic address: rivers@georgeinstitute.org.au.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ivers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality* / Q000534:rehabilitation; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D014193:Trauma Centers / Q000592:standards*; D014194:Traumatology / Q000592:standards*
keywords: Mortality; Quality improvement; Trauma