Ruchholtz Steffen, Waydhas Christian, Lewan Ulrike, Piepenbrink Karl, Stolke Dietmar, Debatin Jörg, Schweiberer Leonhard, Nast-Kolb Dieter
Department of Trauma Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany.
Intensive Care Med. 2002 Oct;28(10):1395-404. doi: 10.1007/s00134-002-1446-8. Epub 2002 Aug 13.
The impact of a multidisciplinary quality management system (MQMS) on the early treatment of severely injured patients was tested.
Prospective clinical study in two level 1 trauma centers.
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).
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%).
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
测试多学科质量管理系统（MQMS）对重伤患者早期治疗的影响。
在两个一级创伤中心进行的前瞻性临床研究。
MQMS包括一份记录协议、20项评估标准以及由质量控制圈对数据进行评判。在慕尼黑实施后（第一阶段，n = 90；第二阶段，n = 77），在埃森进行了验证（第一阶段，n = 175；第二阶段，n = 150）。
在放射诊断以及重度创伤性脑损伤患者的计算机断层扫描前，诊断时间显著节省，表明诊断有所改善。在失血性休克患者中，输血前时间减少（慕尼黑从49分钟降至14分钟；埃森从31分钟降至22分钟），急诊手术前时间也减少（慕尼黑从74分钟降至43分钟；埃森从69分钟降至45分钟）。慕尼黑开颅手术前时间从97分钟降至67分钟。慕尼黑危及生命损伤的延迟诊断发生率从6%降至3%（埃森未发现）。TRISS技术显示两个医院在第二阶段死亡率均有所降低（慕尼黑：TRISS为15.4%，观察到的死亡率为9.1%；埃森：17.8%对11.3%）。
MQMS在治疗效果和结果方面改善了重伤患者的早期临床治疗。MQMS的有效性在两家不同医院得到了体现
