title: Quality improvement practices used by teaching versus non-teaching trauma centres: analysis of a multinational survey of adult trauma centres in the United States, Canada, Australia, and New Zealand.
abstract: BACKGROUND
  Although studies have suggested that a relationship exists between hospital teaching status and quality improvement activities, it is unknown whether this relationship exists for trauma centres.
  
  
  METHODS
  We surveyed 249 adult trauma centres in the United States, Canada, Australia, and New Zealand (76% response rate) regarding their quality improvement programs. Trauma centres were stratified into two groups (teaching [academic-based or -affiliated] versus non-teaching) and their quality improvement programs were compared.
  
  
  RESULTS
  All participating trauma centres reported using a trauma registry and measuring quality of care. Teaching centres were more likely than non-teaching centres to use indicators whose content evaluated treatment (18% vs. 14%, p < 0.001) as well as the Institute of Medicine aim of timeliness of care (23% vs. 20%, p < 0.001). Non-teaching centres were more likely to use indicators whose content evaluated triage and patient flow (15% vs. 18%, p < 0.001) as well as the Institute of Medicine aim of efficiency of care (25% vs. 30%, p < 0.001). While over 80% of teaching centres used time to laparotomy, pulmonary complications, in hospital mortality, and appropriate admission physician/service as quality indicators, only two of these (in hospital mortality and appropriate admission physician/service) were used by over half of non-teaching trauma centres. The majority of centres reported using morbidity and mortality conferences (96% vs. 97%, p = 0.61) and quality of care audits (94% vs. 88%, p = 0.08) while approximately half used report cards (51% vs. 43%, p = 0.22).
  
  
  CONCLUSIONS
  Teaching and non-teaching centres reported being engaged in quality improvement and exhibited largely similar quality improvement activities. However, differences exist in the type and frequency of quality indicators utilized among teaching versus non-teaching trauma centres.
authors.affiliation: Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, McCaig Tower, 3134 Hospital Drive NW, Calgary, AB T2N 2T9, Canada. vikas.chaubey@albertahealthservices.ca.
authors.forename: Vikas P
authors.initials: VP
authors.lastname: Chaubey
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roberts
authors.forename: Mauricio B
authors.initials: MB
authors.lastname: Ferri
authors.forename: Niklas H
authors.initials: NH
authors.lastname: Bobrovitz
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
mesh_terms: D000328:Adult; D001315:Australia; D002170:Canada; D003625:Data Collection; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D009520:New Zealand; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D014193:Trauma Centers / Q000592:standards*; D014481:United States