Establishing the Evidence Base for Trauma Quality Improvement: A Collaborative WHO‐IATSIC Review

Juillard, Catherine; Mock, Charles; Goosen, Jacques; Joshipura, Manjul; Civil, Ian

doi:10.1007/s00268-009-9959-8

Cited by 69 publications

(46 citation statements)

References 71 publications

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“…However, the aim of this study was to assess the current level and form of implementation, rather than to establish the evidence-base for QI programs, as this has been previously reported. 7 …”

Section: Discussionmentioning

confidence: 99%

“…In addition, increased publication of successful examples of QI from LMICs should be prioritized in order to motivate providers, and provide models for future programs. 7,35,36 Nationally, the authors propose that a preventable death in a young victim of trauma should be just as “anathema” as a maternal death, with mandatory reporting to the ministry of health, and thus with a similar health system prioritization of excellence in care provided to victims of trauma. On a global scale, there is a need for increased dissemination of QI programs as a means of empowering local providers to participate in their health systems as planners, system-thinkers, and as agents for change.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 The World Health Organization (WHO) has recognized the key role of QI programs in trauma care. This is evidenced by inclusion of dedicated guidelines for QI as one of three seminal WHO guidelines directed at improving global trauma care.…”

Section: Introductionmentioning

confidence: 99%

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Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on

LaGrone

Pozo

Figueroa

et al. 2017

Injury

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Introduction Trauma quality improvement (QI) programs have been shown to improve outcomes and decrease cost. These are high priorities in low- and middle-income countries (LMICs), where 2,000,000 deaths due to survivable injuries occur each year. We sought to define areas for improvement in trauma QI programs in four LMICs. Methods We conducted a survey among trauma care providers in four Andean middle-income countries: Bolivia, Colombia, Ecuador, and Peru. Results 336 physicians, medical students, nurses, administrators and paramedical professionals responded to the cross-sectional survey with a response rate greater than 90% in all included countries except Bolivia, where the response rate was 14%. Eighty-seven percent of respondents reported morbidity and mortality (M&M) conferences occur at their hospital. Conferences were often reported as infrequent – 45% occurred less than every three months and poorly attended – 63% had five or fewer staff physicians present. Only 23% of conferences had standardized selection criteria, most lacked documentation – notes were taken at only 35% of conferences. Importantly, only 13% of participants indicated that discussions were routinely followed-up with any sort of corrective action. Multivariable analysis revealed the presence of standardized case selection criteria (OR 3.48, 95% CI 1.16–10.46), written documentation of the M&M conferences (OR 5.73, 95% CI 1.73–19.06), and a clear plan for follow-up (OR 4.80, 95% CI 1.59–14.50) to be associated with effective M&M conferences. Twenty-two percent of respondents worked at hospitals with a trauma registry. Fifty-two percent worked at institutions where autopsies were conducted, but only 32% of those reported the autopsy results to ever be used to improve hospital practice. Conclusions M&M conferences are frequently practiced in the Andean region of Latin America but often lack methodologic rigor and thus effectiveness. Next steps in the maturation of QI programs include optimizing use of data from autopsies and registries, and systematic follow-up of M&M conferences with corrective action to ensure that these activities result in appreciable changes in clinical care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on

LaGrone

Pozo

Figueroa

et al. 2017

Injury

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“…To bring about positive behavioral changes, attention should be directed towards young people before they are actually allowed to drive 67. The aim of this review is to discuss the magnitude of the problem of road traffic accidents (RTAs) in Saudi Arabia and suggest the establishment of a trauma care system as a solution to improve trauma outcomes 8–10…”

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confidence: 99%

Trauma care systems in Saudi Arabia: an agenda for action

2010

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Saudi Arabia is undergoing a rapid population growth that along with improved socioeconomics has led many individuals to own a car or even a number of cars per family, resulting in a greater number of vehicles on the roads. The reduced focus on good public transportation systems and the dependence on cars for transportation have created a diversity of drivers who are unfamiliar with the local driving rules and lack the basic skills for safe driving. This is in addition to some young drivers who frequently violate traffic laws and tend to speed most of the time. This unplanned expansion in road traffic has resulted in more car accidents, injuries, disabilities, and deaths. Accompanying that is an increased socioeconomic burden, depletion of human resources, emotional and psychological stress on families, and a strain on healthcare facilities. If this continues without prompt intervention, it will lead to increased insurance premiums and may become unmanageable. To minimize this impact, a national or regional multidisciplinary trauma system has to be developed and implemented. A trauma system is a preplanned, comprehensive, and coordinated regional injury response network that includes all facilities with the capability to care for the injured. Essential components of the system include trauma prevention, prehospital care, hospital care, rehabilitation, system administration, trauma care education and training, trauma care evaluation and quality improvement, along with the participation of society. Research has documented a significant decrease in morbidity and mortality from trauma after the implementation of such systems, depending on their efficiency. The purpose of this review is to discuss the problem of road traffic accidents in this country and address the trauma care system as an effective solution.

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“…Studies have shown that injury-related mortality is twice the expected rate in multiple Indian hospitals (Deshmukh et al, 2012;Murlidhar & Roy, 2004). Trauma quality improvement programs that rely on trauma registries have been shown to be effective in improving care, decreasing mortality, and reducing cost (Juillard, Mock, Goosen, Joshipura, & Civil, 2009).…”

Section: Introductionmentioning

confidence: 99%

Patterns of injury mechanism at a tertiary trauma center in Mumbai, India: Opportunities for injury prevention

Laytin

Kumar

Sarang

et al. 2016

Journal of Transportation Safety & Security

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This study aims to describe patterns of injury mechanism among patients treated at a tertiary trauma center in Mumbai to identify opportunities for targeted injury prevention strategies. Data were collected from an institutional trauma registry, and all patients presenting with life-or limb-threatening injuries over a 16-month period were included. Univariate and bivariate analyses were performed for demographic characteristics, injury mechanisms, and clinical outcomes. A total of 1,115 patients were treated during the study period, and the in-hospital mortality rate was 32% in this severely injured cohort. More than one half of patients were suffered transportation injuries (58%). Of victims of transportation injuries, 45% were victims of railway injuries and 28% were pedestrians struck by motor vehicles. Mortality was highest among victims of railway injuries (42%) and pedestrians struck by automobiles (38%). Although injury prevention is a major public health concern worldwide, it is important to understand local patterns of injury to guide targeted prevention strategies. This study highlights the utility of trauma registries in collecting crucial injury surveillance data. In this context, a focus on pedestrian safety and railway injury prevention is warranted.

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Establishing the Evidence Base for Trauma Quality Improvement: A Collaborative WHO‐IATSIC Review

Cited by 69 publications

References 71 publications

Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on

Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on

Trauma care systems in Saudi Arabia: an agenda for action

Patterns of injury mechanism at a tertiary trauma center in Mumbai, India: Opportunities for injury prevention

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