Guidelines for Trauma Quality Improvement Programmes

by World Health Organization

• ISBN13: 9789241597746
• ISBN10: 9241597747
• Edition: 1st
• Format: Paperback
• Copyright: 2009-09-01
• Publisher: STYLUS PUBLISHING LLC

Summary

In order to promote greater implementation of effective, affordable and sustainable trauma systems globally, the World Health Organization and the International Association for Trauma Surgery and Intensive Care have worked collaboratively to produce these guidelines on trauma quality improvement. The response to the growing problem of injury needs to include the improvement of care of the injured. Quality improvement (QI) programs offer an affordable and sustainable means to implement such improvements. These programs enable health care institutions to better monitor trauma care services, better detect problems in care, and more effectively enact and evaluate corrective measures targeted at these problems. The goal of this publication is to give guidance on ways in which health care institutions globally can implement QI programs oriented to strengthening care of the injured. This guidance is intended to be universally applicable to all countries, no matter what their economic level. These guidelines provide basic definitions and an overview of the field of QI, so that those not familiar with this field will have a working knowledge of it. Evidence of the benefit of QI in general and trauma QI in particular is then laid out. The main part of the publication reviews the most common methods of trauma QI, written in a how-do-to fashion. This covers a wide range of techniques. The first two of these are especially emphasized as ways in which to strengthen trauma QI in the setting of low-income and middle-income countries.

Table of Contents

Preface	p. v
Contributors	p. vii
Acknowledgements	p. viii
Executive Summary	p. 1
Introduction	p. 4
Overview of quality improvement	p. 6
Definitions and basics of quality improvement	p. 6
Elements of quality improvement	p. 9
Benefits of quality improvement programmes	p. 13
Review of benefits of trauma quality improvement in the medical literature	p. 13
Experience of trauma quality improvement in low- and middle-income countries	p. 14
Experience of quality improvement in other fields in low-and middle-income countries	p. 16
Status of trauma quality improvement globally	p. 19
Techniques of trauma quality improvement	p. 22
Morbidity and mortality (M & M) conferences	p. 22
Trauma quality improvement committee	p. 23
Preventable death panel review	p. 25
Constituting the panel	p. 26
Preparation of data for the review	p. 27
Specifics of the case review process	p. 30
Inclusion of involved care providers on the panel: potential for bias	p. 31
Preventable death panels: documentation of discussion and analysis	p. 32
Preventable death panels: a summary	p. 32
Tracking of audit filters, complications, errors, adverse events, and sentinel events	p. 34
Audit filters	p. 34
Usefulness of audit filters	p. 36
Complications, adverse events, errors, and sentinel events	p. 37
Classification of errors	p. 40
Statistical methods: risk-adjusted mortality	p. 40
Corrective strategies and closing the loop	p. 44
Guidelines, pathways, and protocols	p. 44
Targeted education	p. 44
Actions for improvement targeted at specific providers	p. 46
Enhanced resources, facilities, or communication	p. 47
Closing the loop	p. 48
System-wide and prehospital quality improvement	p. 49
Role of medical records and trauma registry	p. 51
Appropriateness of different techniques at different levels of the health care system	p. 54
Overlap of these guidelines with other activities	p. 57
Clinical algorithms	p. 57
Patient safety	p. 58
Strengthening of health care management	p. 59
References	p. 60
Annexes	p. 68
Details of literature review of benefits of trauma quality improvement	p. 68
Sample quality improvement tracking form	p. 77
Sample data sheet for use in preventable death panel reviews	p. 79
Sample individual cases for review	p. 81
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