RTCC Performance Improvement South East Regional Trauma Coordinating Committee Meeting January 9, 2009 Temecula, CA

Trauma Care System Definition “ A trauma care system may be defined as an organized approach to the acutely injured patient that provides personnel, facilities,and equipment for optimal care on an emergency basis within a defined geographic area.” Maull, K., Esposito, T.

Historical Perspective  Shift scope of management – Individual patient, hospital based approach – Organized regional/system approach

System Continuum Components  Prehospital care  In-hospital care  Rehabilitation  Research driven quality assurance

Goals of Trauma System  Right patient  Right facility  Right time frame

Basis for Regionalization  Maximize efficiencies  Pool resources  Optimize outcomes – Decrease mortality – Decrease morbidity  Reduce costs

Trauma System Components  “Inclusive System” ( HRSA)  Public Information, education, injury prevention  Human Resources  Prehospital care – Communications – Medical Direction – Triage – Transport

Trauma System Components  Trauma Care Facilities – Level I, II, III, IV  Acute care facilities within the system  Specialty Trauma Centers – Burns – Pediatrics – Spinal Cord – Hand replantation

Trauma System Components  Interfacility transfer  Rehabilitation  System Evaluation  Research

Trauma System Quality Assurance/ Performance Improvement  Importance cannot be overstated  Monitor quality of care throughout continuum  Establish standards of care  Develop surveillance monitors – Audit filters; indicators  Process for review – Documentation – Corrective action – Uniform application throughout system – Reassessment

Systems Process Improvement  Identify Challenges  Develop process indicators  Approach – Must fit environment – Cannot be one size fits all – Must be measurable – Must be meaningful

Special Consideration  Urban trauma care systems – Patient care access – Prehospital provider risks – Volume – Over vs undertriage  Rural trauma care systems – Transport times – Patient care access – Resources; facilities and personnel

Special Considerations  Pediatrics  Geriatric care  Disaster preparedeness – Mass casualty response – Coordination of resources

Current Programs for System Development and Evaluation  Health Resources and Services Administration – Model Trauma System Planning and Evaluation (MTSPE)  American College of Surgeons – Regional Trauma Systems: Optimal Elements, Integration and Assessment

ACS System Wide QA & Evaluation Trauma Lead Agency Responsibility  Evaluate – Effectiveness of injury prevention initiatives – Access to care – Availability of services – Quality of services throughout continuum Prehospital through rehab – Community integration – Financial impact

ACS System Wide QA & Evaluation  Delineation of valid objective metrics – Ongoing quality audit – Patient outcomes Benchmarks Clinical evidence  MIS (Trauma Management Information) – Support data collection – Support data analysis

System Wide QA and Evaluation  Standardized Data Collection is Key  Consider Compliance with CEMSIS Trauma Data Dictionary (NTDS-based)  Standardized Mortality Definitions

ACS System Wide QA & Evaluation  Establish forums for multidisciplinary and multi agency review  Evaluation of system integration and effectiveness  Customer satisfaction surveys  Strategic planning  Accountability for achieving defined goals

ACS PRQ (Systems)  Membership and reporting structure  System Integration PI efforts – Dispatch,prehospital,TCs, acute care, rehab  PI and outcomes measures tracked – Includes special populations  Specific examples – Transport times to definitive care – Undertriage rates – Overtriage rates

Opportunities and Challenges  Opportunities and Options – Use previously developed programs – Home grown  Indicators for QA and PI  Surveillance tools  Accountability  Authority  Tracking Tools

Discussion and Questions?