Ruchholtz S, Waydhas C, Aufmkolk M, Täger G, Piepenbrink K, Stolke D, Nast-Kolb D
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinkum Essen, Hufelandstrasse 55, 47145 Essen.
Unfallchirurg. 2001 Oct;104(10):927-37. doi: 10.1007/s001130170033.
A multidisciplinary quality management system (QMS) for the early treatment of severely injured patients was validated in a trauma center in Germany. In the presented prospective study a QMS developed at another trauma center was implemented at the department of trauma surgery of the University of Essen for the presented study. The essential elements of the QMS were the establishment of (1) an adequate protocol for documentation, (2) 20 criteria for the assessment of treatment quality, (3) regular statistical analysis of treatment quality and (4) a quality circle comprising all medical specialties for data discussion. From 5/98-9/99 a cohort of 447 patients with an average injury severity score (ISS) of 22 +/- 17 was treated in the emergency department. The impact of the QMS was assessed in 4 periods (1: 5/1998-8/1998; 2: 9-12/1998; 3: 1-4/1999; 4: 5-8/1999). The quality circle met 8 times. For the improvement of the process 16 long-term changes were introduced. In 60% (n = 12) of the 20 assessment criteria significant improvements were detected. In diagnostics there were significant reductions of the time needed for basic radiological and sonographic check-up (from 24 +/- 12 min in the first to 14 +/- 8 min in the last period) and of the duration until performance of a cranial computed tomography in severe traumatic brain injury (sTBI; from 45 +/- 22 to 28 +/- 8 min). The rate of delayed diagnoses remained low (4% in the first, 5% in the last period). Further positive changes were the time savings in transfusion (from 35 +/- 20 to 20 +/- 4 min) and emergency operations (from 67 +/- 20 to 48 +/- 4 min) in hemorrhagic shock as well as for craniotomies (77 +/- 41 to 54 +/- 19 min) in sTBI. Apart from the significant time reductions other improvements were found. Overall mortality was diminished from 17% in the first to 10% in the last observation period. In conclusion the study revealed that the quality of the early therapy of severely injured patients was significantly improved by implementation of a multidisciplinary quality management system especially with respect to treatment efficiency.
在德国一家创伤中心验证了一种用于严重受伤患者早期治疗的多学科质量管理体系（QMS）。在本前瞻性研究中，另一家创伤中心开发的QMS在埃森大学创伤外科实施用于本研究。QMS的基本要素包括：（1）建立适当的文件记录协议；（2）20条治疗质量评估标准；（3）定期对治疗质量进行统计分析；（4）由所有医学专科组成的质量改进小组进行数据讨论。从1998年5月至1999年9月，急诊科共治疗了447例平均损伤严重度评分（ISS）为22±17的患者。在4个时间段（1：1998年5月至8月；2：1998年9月至12月；3：1999年1月至4月；4：1999年5月至8月）评估了QMS的影响。质量改进小组共召开了8次会议。为改进流程引入了16项长期变革。在20项评估标准中的60%（n = 12）发现了显著改进。在诊断方面，基础放射学和超声检查所需时间显著减少（从第一阶段的24±12分钟降至最后阶段的14±8分钟），重度创伤性脑损伤（sTBI）患者进行头颅计算机断层扫描的时间也显著缩短（从45±22分钟降至28±8分钟）。延迟诊断率仍然较低（第一阶段为4%，最后阶段为5%）。其他积极变化包括失血性休克患者输血时间（从35±20分钟降至20±4分钟）和急诊手术时间（从67±20分钟降至48±4分钟）以及sTBI患者开颅手术时间（从77±41分钟降至54±19分钟）的节省。除了时间显著减少外，还发现了其他改进。总体死亡率从第一阶段的17%降至最后观察阶段的10%。总之，该研究表明，实施多学科质量管理体系可显著提高严重受伤患者的早期治疗质量，尤其是在治疗效率方面。
