Trauma emergency unit: long-term evaluation of a quality assurance programme

Abstract

Objective-Long term evaluation of a quality assurance programme (after an assessment in 1993). Design-Review of medical records. Setting-Emergency area of an orthopaedic, trauma, and plastic surgery unit in a French teaching hospital (Besançon). Subjects-1187 consecutive ambulatory patients' records, from July 1995. Main measures-Occurrence of near adverse events (at risk events causing situations which could lead to the occurrence of an adverse event). Results-71 near adverse events were identified (5.9% of the ambulatory visits). There was a significant decrease in the rate of near adverse events between 1993 (9.9% (2056 ambulatory visits, 204 near adverse events)), and 1995 (5.9% (1187 ambulatory visits, 71 near adverse events)), and significant change in the proportion of each category of adverse event (decrease in departures from prevention protocols). Conclusions-Despite their limitations, the eVectiveness and eYciency of quality assurance programmes seem to be real and valuable. Maintaining quality improvement requires conditions which include some of the basic principles of total quality management (leadership, participatory management, openness, continuous feed back). The organisation of this unit as a specialised trauma centre was also a determining factor in the feasibility of a quality assurance programme (specialisation and small size, high activity volume, management of the complete care process). Quality assurance is an important initial step towards quality improvement, that should precede consideration of a total quality management programme.

Errors in packaging surgical instruments based on a surgical instrument tracking system: an observational study

“…[ 1 , 2 ] Surgical quality can be influenced by various factors in clinics, such as clinicians’ skill, and the management of surgical instruments and supplies [ 3 ]. Various methods have been used to improve surgical quality in clinics [ 4 ], including surgical team checklists [ 5 ], evidence-based protocols [ 6 ], surgeon performance [ 7 ], and staff education [ 8 ]. However, as far as we know, only one study has focus on improving quality and safety in surgical sterile instrument processing [ 3 ].…”

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

“…One study assessed the effect of a QI program on near‐adverse events in orthopedic, trauma, and plastic surgery patients. The frequency decreased from 9.9% to 5.9% over 2 years, and there were statistically significant reductions in each subcategory of near‐adverse events [10]. Welch and Allen report on a QI program intended to decrease emergency department turnaround times, decrease the number of patients leaving against medical advice, and improve overall patient satisfaction in the emergency department.…”

Lean methodology for performance improvement in the trauma discharge process

“…These include setting a target discharge date, formalizing a commitment to discharge goals with set discharge appointments, 12 leveraging night staff to jump start the discharge process, targeting long-stay patients with a consistent case manager, smoothing postYacute care transfers, eliminating documentation redundancies, and engaging clinical staff with the data for ongoing performance improvement pilots. 5,6,8 This leads to perhaps the most important lesson from this project: even when a process is in place, it needs continual maintenance, and new issues will continually arise. The final point of lean processing must be kept in mind: continual improvement must be performed.…”