Process indicators: tools for monitoring the management of severe trauma cases in Catalonia

Autores de I3PT

• 

  Salvador Navarro Soto

  Autor

Participantes ajenos a I3PT

• Prat, S
• Muñoz-Ortiz, L
• Koo, M
• Jiménez-Fábrega, X
• Martínez-Cruz, O
• Espallargues, M
• Grp Expertos Traumcat
• Grp Trabajo Traumcat

Grupos de Investigación

• Politraumatisme, cirurgia d'urgències i medicina transfusional

  

  Investigador

  Salvador Navarro Soto

Abstract

Background and objectives. Process indicators have been widely used to monitor the way trauma care is provided. We aimed to analyze whether data from a hospital's severe trauma register could facilitate the evaluation of aspects of the initial management of severe injuries. Methods. Observational, retrospective population-based study. A working group of experts selected a set of trauma care process indicators relevant to some aspects of initial care, diagnosis, and treatment of severely injured patients. Four of the indicators referred to prehospital care and 5 to hospital care. We calculated the observed and expected compliance rates for all the indicators. Results. A total of 1526 cases (44.4%) were analyzed for 2013; 1908 (55.6%) were analyzed for 2014. We were able to evaluate 3 of the 4 prehospital process indicators: endotracheal intubation in patients with a score of <= 8 on the Glasgow coma scale (GCS) (84% compliance), venous access established before hospital arrival (83.4%), and placement of a neck collar to immobilize the cervical spine (72.7%). Compliance for the hospital-phase indicators were as follows: performance of a computed tomography scan of the head within 60 minutes in cases with a GCS of <= 13 (5.3% compliance, craniotomy in candidate patients within 2 hours of diagnosis (65%), diagnostic examination for abdominal injuries within 60 minutes in patients with systolic blood pressures <= 90 mm Hg (89.3%), and therapeutic laparotomy or angiography within 4 hours of abdominal injury in candidate patients with systolic blood pressure <= 90 mm Hg (51.7%). Compliance was 69.9% for the last process indicator: surgical treatment of open fractures within 8 hours of an accident. Conclusion. Our findings show that a hospital trauma register provides data about care process indicators that can allow us to monitor the quality of care of severely injured patients.

Keywords

• Process indicators; Trauma care; Trauma register; Outcome analysis