Quality improvement practices used by teaching versus non-teaching trauma centres: analysis of a multinational survey of adult trauma centres in the United States, Canada, Australia, and New Zealand

BMC Surgery

Henry T Stelfox¹  Niklas H Bobrovitz¹  Mauricio B Ferri¹  Derek J Roberts¹  Vikas P Chaubey¹ 

[1] Department of Community Health Sciences, University of Calgary, Teaching, Research & Wellness Building, 3rd Floor, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada

关键词: Survey;    Teaching status;    Trauma quality improvement;   

Others  :  1090709
DOI  :  10.1186/1471-2482-14-112

 received in 2014-01-01, accepted in 2014-12-17,  发布年份 2014

【 摘 要 】

Background

Although studies have suggested that a relationship exists between hospital teaching status and quality improvement activities, it is unknown whether this relationship exists for trauma centres.

Methods

We surveyed 249 adult trauma centres in the United States, Canada, Australia, and New Zealand (76% response rate) regarding their quality improvement programs. Trauma centres were stratified into two groups (teaching [academic-based or –affiliated] versus non-teaching) and their quality improvement programs were compared.

Results

All participating trauma centres reported using a trauma registry and measuring quality of care. Teaching centres were more likely than non-teaching centres to use indicators whose content evaluated treatment (18% vs. 14%, p < 0.001) as well as the Institute of Medicine aim of timeliness of care (23% vs. 20%, p < 0.001). Non-teaching centres were more likely to use indicators whose content evaluated triage and patient flow (15% vs. 18%, p < 0.001) as well as the Institute of Medicine aim of efficiency of care (25% vs. 30%, p < 0.001). While over 80% of teaching centres used time to laparotomy, pulmonary complications, in hospital mortality, and appropriate admission physician/service as quality indicators, only two of these (in hospital mortality and appropriate admission physician/service) were used by over half of non-teaching trauma centres. The majority of centres reported using morbidity and mortality conferences (96% vs. 97%, p = 0.61) and quality of care audits (94% vs. 88%, p = 0.08) while approximately half used report cards (51% vs. 43%, p = 0.22).

Conclusions

Teaching and non-teaching centres reported being engaged in quality improvement and exhibited largely similar quality improvement activities. However, differences exist in the type and frequency of quality indicators utilized among teaching versus non-teaching trauma centres.

【 授权许可】

   
2014 Chaubey et al.; licensee BioMed Central.

【 参考文献 】

• [1]Committee on Trauma American College of Surgeons: Resources for Optimal Care of the Injured Patient 2006. Chicago, IL: Committee on Trauma American College of Surgeons; 2006.
• [2]Juillard CJ, Mock C, Goosen J, Joshipura M, Civil I: Establishing the evidence base for trauma quality improvement: a collaborative WHO-IATSIC review. World J Surg 2009, 33(5):1075-1086.
• [3]Maier RV, Rhodes M, et al.: Trauma performance improvement. In Injury Control. Edited by Rivara FP, Cummings P, Koepsell TD. Cambridge: Cambridge University Press; 2009.
• [4]Stelfox HT, Straus SE, Nathens A, Bobranska-Artiuch B: Evidence for quality indicators to evaluate adult trauma care: a systematic review. Crit Care Med 2011, 39(4):846-859.
• [5]Stelfox HT, Straus SE, Nathens A, Gruen RL, Hameed SM, Kirkpatrick A: Trauma center quality improvement programs in the United States, Canada, and Australasia. Ann Surg 2012, 256(1):163-169.
• [6]Demetriades D, Martin M, Salim A, Rhee P, Brown C, Chan L: The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg 2005, 242(4):512-517. discussion 517–519
• [7]Nathens AB, Jurkovich GJ, Maier RV, Grossman DC, MacKenzie EJ, Moore M, Rivara FP: Relationship between trauma center volume and outcomes. JAMA 2001, 285(9):1164-1171.
• [8]Papanikolaou PN, Christidi GD, Ioannidis JP: Patient outcomes with teaching versus nonteaching healthcare: a systematic review. PLoS Med 2006, 3(9):e341.
• [9]Todd SR, Arthur M, Newgard C, Hedges JR, Mullins RJ: Hospital factors associated with splenectomy for splenic injury: a national perspective. J Trauma 2004, 57(5):1065-1071.
• [10]Kupersmith J: Quality of care in teaching hospitals: a literature review. Acad Med 2005, 80(5):458-466.
• [11]Stelfox HT, Bobranska-Artiuch B, Nathens A, Straus SE: Quality indicators for evaluating trauma care: a scoping review. Arch Surg 2010, 145(3):286-295.
• [12]Stelfox HT, Khandwala F, Kirkpatrick AW, Santana MJ: Trauma center volume and quality improvement programs. J Trauma Acute Care Surg 2012, 72(4):962-967.
• [13]Baker SP, O'Neill B, Haddon W Jr, Long WB: The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974, 14(3):187-196.