Quality management for trauma patients in the emergency department

The quality of care for trauma patients seems to have dramatically improved in the last decades. Both political and medical changes have influenced these changes. In the Netherlands the organization of a trauma system started in the eighties of last century with the foundation of the Dutch Trauma Society and regionalized care systems. Also the introduction of Advanced Trauma Life Support (ATLS) worldwide allowed for an improvement in quality. Although quality and safety worldwide have a growing attention, it is difficult for health care professionals to catch up with managers and politicians in their enthusiasm to build a safer system. Professionals are not only busy with quality and its evidence, but in the mean time also have to make patients better. This thesis describes five investigations that really are a mirror for quality in daily practice. In Chapter 2 a continuous video surveillance of trauma team performance in the emergency department was analyzed to judge the quality of the team real-time. Teamleader efficency improved team performance. Chapter 3 examined the impact of a change in protocol of spine board removal in polytrauma patients. Results showed an important outcome for this patient group: they no longer have to stay on these awkward boards indefinitely, but now can be removed from these boards upon arrival in the ED. Chapter 4 moreover showed that indeed these spineboards objectively show minimal support and comfort for trauma patients. Although earlier in experimental settings an improvement of immobilization had been shown, clinical evaluation did not confirm this. Chapter 5 screened the necessity of renewed trauma team examination in the receiving hospital after transfer of a polytraumatized patient. Considered the large number of newly found diagnosis in these patients (of which only a few warranted invasive treatment) it is possible that after a direct transfer to a specialized unit these injuries might not be detected. Finally in Chapter 6 we analyzed the quality of radiological interpretation for acute knee injuries in a university medical centre. This outcome study showed that despite several safety measures still a large percentage of knee injuries is misinterpreted in the emergency department. No specific risk factors for misinterpretation could be defined. These investigations are relevant to the healthcare professional and seems to describe quality better then nationwide process or structure indicators. From other studies it is clear that medical specialists are better in improving quality than politicians and managers. Indications for quality items can very well be obtained from problems that are encountered in daily practice. To support the professionals in quality management a stubborn IT support is indispensable. As improving quality asks for changing behavior it is indispensable to start educational programs on quality management and patient safety and create a safer and safety culture