一种提高创伤团队激活效果的质量改进方法。
A quality-improvement approach to effective trauma team activation.
机构信息
From the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Verhoeff); the Department of Surgery, University of Alberta, Edmonton, Alta. (Saybel, Fawcett, Tsang, Widder); and the Department of Medicine, University of Alberta, Edmonton, Alta. (Mathura).
出版信息
Can J Surg. 2019 Oct 1;62(5):305-314. doi: 10.1503/cjs.000218.
BACKGROUND
Appropriate, timely trauma team activation (TTA) can directly affect outcomes for patients with trauma. A review of quality-performance indicators at our Canadian level 1 trauma centre showed a high level of undertriage, with TTA compliance rates less than 60% for major trauma. A quality-improvement project was undertaken, targeting a sustained goal of at least 90% TTA compliance based on Accreditation Canada guidelines.
METHODS
Quality-improvement action followed a well-defined process. Baseline data collection was performed, and, in keeping with the Donabedian approach, we brought together stakeholders to collectively review and understand the reasons behind poor TTA compliance; and root-cause analysis. This was followed by rapid change cycles that focused on structure and processes with ongoing audits to support and sustain change.
RESULTS
Trauma team activation compliance improved from 58.8% to more than 90% over 2 years. Quality indicators showed a statistically significant reduction in the time to computed tomography scanner, time in the acute care region of the emergency department and total time in the emergency department, with improved TTA compliance.
CONCLUSION
Compliance with TTA protocols improved to more than 90% over a 2-year period, which shows the benefit of having a clearly outlined qualityimprovement process. This well-defined quality-improvement method provides a framework for use by other institutions that seek to improve their processes of trauma care, including activation rates.
背景
适当且及时的创伤急救小组激活（TTA）可以直接影响创伤患者的预后。对我们加拿大一级创伤中心的质量绩效指标进行审查后发现，分诊过度的情况较为严重，重大创伤的 TTA 符合率低于 60%。因此开展了一项质量改进项目，目标是根据加拿大认证机构的指南，将 TTA 的符合率持续保持在 90%以上。
方法
质量改进行动遵循明确的流程。进行了基线数据收集，并按照 Donabedian 方法，召集利益相关者共同审查和了解 TTA 符合率低的原因，并进行根本原因分析。随后进行了快速变革周期，重点关注结构和流程，并进行持续审核以支持和维持变革。
结果
TTA 激活符合率在两年内从 58.8%提高到 90%以上。质量指标显示，在 CT 扫描仪的使用时间、急诊部急性护理区的停留时间和急诊部总停留时间方面均有显著统计学意义的减少，TTA 符合率也得到了提高。
结论
TTA 方案的符合率在两年内提高到 90%以上，这表明有明确规定的质量改进流程具有优势。这种定义明确的质量改进方法为其他希望改进创伤护理流程（包括激活率）的机构提供了一个框架。
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