Cole, E., Lecky, F., West, A. et al. (3 more authors) (2016) The impact of a pan-regional inclusive trauma system on quality of care. Annals of Surgery, 264 (1). pp. 188-194. ISSN 0003-4932
Abstract
© 2016 Wolters Kluwer Health, Inc.Objectives: To evaluate the impact of the implementation of an inclusive pan-regional trauma system on quality of care. Background: Inclusive trauma systems ensure access to quality injury care for a designated population. The 2007 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found quality deficits for 60% of severely injured patients. In 2010, London implemented an inclusive trauma system. This represented an opportunity to evaluate the impact of a pan-regional trauma system on quality of care. Methods: Evaluation of the London Trauma System (ELoTS) utilized the NCEPOD study core methodology. Severely injured patients were identified prospectively over a 3-month period. Data were collected from prehospital care to 72h following admission or death. Quality, processes of care, and outcome were assessed by expert review using NCEPOD criteria. Results: Three hundred and twenty one severely injured patients were included of which 84% were taken directly to a major trauma center, in contrast to 16% in NCEPOD. Overall quality improved with the proportion of patients receiving "good overall care" increasing significantly [NCEPOD: 48% vs ALL-ELoTS: 69%, RR 1.3 (1.2 to 1.4), P<0.01], primarily through improvements in organizational processes rather than clinical care. Improved quality was associated with increased early survival, with the greatest benefit for critically injured patients [NCEPOD: 31% vs All-ELoTS 11%, RR 0.37 (0.33 to 0.99), P=0.04]. Conclusions: Inclusive trauma systems deliver quality and process improvements, primarily through organizational change. Most improvements were seen in major trauma centers; however, systems implementation did not automatically lead to a reduction in clinical deficits in care.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2016 Wolters Kluwer Health, Inc. This is an author produced version of a paper subsequently published in Annals of Surgery. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | outcomes; quality; regionalization; severe injury; trauma systems |
Dates: |
|
Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 27 Mar 2017 12:21 |
Last Modified: | 03 Aug 2017 22:04 |
Published Version: | https://doi.org/10.1097/SLA.0000000000001393 |
Status: | Published |
Publisher: | Wolters Kluwer Health |
Refereed: | Yes |
Identification Number: | 10.1097/SLA.0000000000001393 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:114149 |