A multidisciplinary quality management system for the early treatment of severely injured patients: implementation and results in two trauma centers

被引:72
作者
Ruchholtz, S
Waydhas, C
Lewan, U
Piepenbrink, K
Stolke, D
Debatin, J
Schweiberer, L
Nast-Kolb, D
机构
[1] Univ Hosp Essen, Dept Trauma Surg, D-45122 Essen, Germany
[2] Univ Hosp Essen, Dept Anesthesiol, D-45122 Essen, Germany
[3] Univ Hosp Essen, Dept Neurosurg, D-45122 Essen, Germany
[4] Univ Hosp Essen, Dept Radiol, D-45122 Essen, Germany
[5] Univ Munich, Klinikum Innenstadt, Dept Surg, D-8000 Munich, Germany
关键词
quality management; early clinical therapy; multiple injuries; severe blunt trauma; penetrating trauma; emergency operation;
D O I
10.1007/s00134-002-1446-8
中图分类号
R4 [临床医学];
学科分类号
1002 [临床医学]; 100602 [中西医结合临床];
摘要
Objective: The impact of a multidisciplinary quality management system (MQMS) on the early treatment of severely injured patients was tested. Design and setting: Prospective clinical study in two level I trauma centers. Methods and materials: MQMS comprised a protocol for documentation, 20 assessment criteria, and the judgement of data by a quality circle. After implementation in Munich (1st period, n=90; 2nd period, n=77) the validation took place in Essen (1st period, n=175; 2nd period, n=150). Results: Improvements in diagnostics were shown by significant time savings in radiological diagnostics and before computed tomography in severe traumatic brain injury. In patients with hemorrhagic shock there was a reduction in time before transfusion (49 to 14 min in Munich; 31 to 22 min in Essen) and before emergency operation (74 to 43 min in Munich; 69 to 45 min in Essen). The time before craniotomy was reduced from 97 to 67 min in Munich. The incidence of delayed diagnosis of life-threatening lesions was diminished from 6% to 3% in Munich (not found in Essen). The TRISS technique showed a reduction in mortality in both hospitals in the second period (Munich: 15.4% TRISS vs. 9.1% observed mortality; Essen: 17.8% vs. 11.3%). Conclusions: MQMS improved early clinical treatment in severe injury with respect to therapeutic effectiveness and outcome. The effectiveness of the MQMS was shown at two different hospitals.
引用
收藏
页码:1395 / 1404
页数:10
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