title: Impact on outcome of a targeted performance improvement programme in haemodynamically unstable patients with a pelvic fracture.
abstract: We describe the impact of a targeted performance improvement programme and the associated performance improvement interventions, on mortality rates, error rates and process of care for haemodynamically unstable patients with pelvic fractures. Clinical care and performance improvement data for 185 adult patients with exsanguinating pelvic trauma presenting to a United Kingdom Major Trauma Centre between January 2007 and January 2011 were analysed with univariate and multivariate regression and compared with National data. In total 62 patients (34%) died from their injuries and opportunities for improved care were identified in one third of deaths. Three major interventions were introduced during the study period in response to the findings. These were a massive haemorrhage protocol, a decision-making algorithm and employment of specialist pelvic orthopaedic surgeons. Interventions which improved performance were associated with an annual reduction in mortality (odds ratio 0.64 (95% confidence interval (CI) 0.44 to 0.93), p = 0.02), a reduction in error rates (p = 0.024) and significant improvements in the targeted processes of care. Exsanguinating patients with pelvic trauma are complex to manage and are associated with high mortality rates; implementation of a targeted performance improvement programme achieved sustained improvements in mortality, error rates and trauma care in this group of severely injured patients.
authors.affiliation: Barts and the London School of Medicine and Dentistry Queen Mary, University of London, London, UK.
authors.forename: Z B
authors.initials: ZB
authors.lastname: Perkins
authors.affiliation: St Georges Healthcare NHS Trust, Blackshaw Road, London, UK.
authors.forename: G D
authors.initials: GD
authors.lastname: Maytham
authors.affiliation: Barts Health NHS Trust, Commercial Road, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Koers
authors.affiliation: Barts Health NHS Trust, Commercial Road, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Bates
authors.affiliation: Barts and the London School of Medicine and Dentistry Queen Mary, University of London, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Brohi
authors.affiliation: Barts and the London School of Medicine and Dentistry Queen Mary, University of London, London, UK.
authors.forename: N R M
authors.initials: NR
authors.lastname: Tai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002985:Clinical Protocols; D003657:Decision Making; D005260:Female; D050723:Fractures, Bone / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006470:Hemorrhage / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000592:standards; D010384:Pelvic Bones / Q000293:injuries*; D058996:Quality Improvement; D012189:Retrospective Studies; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Pelvic fracture; Performance Improvement; Shock; Trauma