Quality management in the early treatment of patients with multiple injuries. II. Quality improvement guidelines

Abstract

To enhance the quality of treatment of patients with multiple injuries (blunt trauma), guidelines for the acute clinical management (trauma-algorithm) were implemented at our clinic in 1994. The impact of these guidelines was analysed, comparing two prospectively recorded collectives of polytraumatized patients 4/1988-12/1993 (A; n = 126) and 1/1994-6/1996 (B; n = 74). Nine specifically defined parameters were used to assess the therapeutic process of early clinical trauma management. All parameters showed an improvement after implementation of the algorithm (group B): (1) Complete radiological and sonographic basic diagnostics in 97% vs. 92% of patients; (2) time interval of 38 min vs. 55 min until cranial CT was done after severe head injury (GCS < 10); (3) reduction of delayed diagnosis of lesions to 5% vs. 24%; (4) duration of 16 min vs. 20 min until intubation; (5) period of 23 min to 30 min to pleural drainage; (6) duration of 18 min vs. 32 min until transfusion in shock; (7) period of 79 min vs. 98 min until emergency operation in shock; (8) duration of 95 min vs. 124 min until trepanation, and (9) operation rate within 24 h after admission to ICU in 3% vs. 12%. The lethality rates of each collective were assessed after subdivision in three groups (I-III) with middle (ISS: 18-24), high (ISS: 25-49) and extreme (ISS: 50-75) injury severity. In all groups of both collectives ISS values, age, initial loss of consciousness (GCS) and shock were comparable (except the higher injury severity of collective B in group I). In all groups a reduction of lethality could be shown for collective B: Group I, 0% vs. 20% (P < 0.05); group II, 8% vs. 24% (P < 0.05); and group III, 40% vs. 71%, not significant because of the small group in B (n = 5). The implementation of therapeutic management guidelines led to an improvement of both treatment processes and outcome. In order to regularly reassess validity and practicability of such guidelines as well as further enhance therapeutic quality, a continuous evaluation programme representing a quality management system should be inaugurated.

Trauma care inside and outside business hours: comparison of process quality and outcome indicators in a German level-1 trauma center

“…Studies consistently report that a trauma room algorithm has a positive effect on patient care [5][6][7]. Concepts like Advanced Trauma Life Support (ATLS) or European Trauma Course (ETC) aim at ensuring efficient trauma room care workflows and preventing secondary injury [8].…”

Primäre bildgebende Diagnostik von polytraumatisierten Patienten mittels Spiralcomputertomographie

“…In den epidemologischen Studien zum Polytrauma zeigt sich mit 65% -80% eine deutliche Dominanz der männlichen Unfallopfer (79,86,101 Eine mögliche Schwierigkeit in der Beurteilung der Milz sehen einige Autoren in der inhomogenen Kontrastmittelaufnahme der Milz, wenn diese in einer arteriell betonten Kontrastmittelphase dargestellt wird (7,59,91). Die CT-Untersuchung des Abdomens kann somit eine wichtige Grundlage zur präziseren Planung des therapeutischen Vorgehens, insbesondere auch der differenzierteren Indikationsstellung zur Laparotomie bilden (65).…”

The effect of paramedic training on pre-hospital trauma care (EPPTC-study): a study protocol for a prospective semi-qualitative observational trial

“…Based on the “lowest common denominator”, ATLS is a concept for training the physicians dealing with severe injured patients in the emergency departments in Germany [13]. Ruchholtz et al showed in the 1990s that procedures based on the guidelines could improve the care of emergency room patients [14]. Evidence of the effect on patient outcome is lacking [15].…”