Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Gyeonggi South Regional Trauma Center, Ajou University Hospital, Suwon, Korea.
J Korean Med Sci. 2021 Jun 7;36(22):e149. doi: 10.3346/jkms.2021.36.e149.
This study examined the impact of the performance improvement and patient safety (PIPS) program implemented in 2015 on outcomes for trauma patients in a regional trauma center established by a government-led project for a national trauma system in Korea.
The PIPS program was based on guidelines by the World Health Organization and American College of Surgeons. The corrective strategies were proceeded according to the loop closure principle: data-gathering and monitoring, identification of preventable trauma deaths (PTDs), evaluation of preventable factors, analysis of findings, and corrective action plans. We established guidelines and protocols for trauma care, conducted targeted education and peer review presentations for problematic cases, and enhanced resources for improvement accordingly. A comparative analysis was performed on trauma outcomes over a four-year period (2015-2018) since implementing the PIPS program, including the number of trauma team activation and admissions, time factors related to resuscitation, ventilator duration, and the rate of PTDs.
Human resources in the center significantly increased during the period; attending surgeons responsible for trauma resuscitation from 6 to 11 and trauma nurses from 85 to 218. Trauma admissions (from 2,166 to 2,786), trauma team activations (from 373 to 1,688), and severe cases (from 22.6 to 33.8%) significantly increased (all < 0.001). Time to initial resuscitation and transfusion significantly decreased from 120 to 36 minutes ( < 0.001) and from 39 to 16 minutes ( < 0.001). Time to surgery for hemorrhage control and decompressive craniotomy improved from 99 to 54 minutes ( < 0.001) and 181 to 135 minutes ( = 0.042). Ventilator duration and rate of PTDs significantly decreased from 6 to 4 days ( = 0.001) and 22.2% to 8.4% ( = 0.008).
Implementation of the PIPS program resulted in improvements in outcomes at a regional trauma center that has just been opened in Korea. Further establishment of the PIPS program is required for optimal care of trauma patients.
本研究旨在探讨 2015 年实施的绩效改进和患者安全（PIPS）计划对韩国一个由政府主导的国家创伤系统项目设立的区域创伤中心创伤患者结局的影响。
PIPS 计划基于世界卫生组织和美国外科医师学会的指南。纠正策略按照循环闭合原则进行：数据收集和监测、确定可预防的创伤死亡（PTD）、评估可预防因素、分析结果和制定纠正行动计划。我们为创伤救治制定了指南和方案，对有问题的病例进行了针对性的教育和同行评审演示，并相应地加强了改进资源。对实施 PIPS 计划后的四年期间（2015-2018 年）的创伤结局进行了比较分析，包括创伤团队激活和入院人数、复苏相关时间因素、呼吸机使用时间和 PTD 发生率。
该中心的人力资源在该期间显著增加；负责创伤复苏的主治外科医生从 6 人增加到 11 人，创伤护士从 85 人增加到 218 人。创伤入院人数（从 2166 人增加到 2786 人）、创伤团队激活人数（从 373 人增加到 1688 人）和严重病例比例（从 22.6%增加到 33.8%）均显著增加（均 <0.001）。初始复苏和输血的时间分别从 120 分钟减少到 36 分钟（<0.001）和从 39 分钟减少到 16 分钟（<0.001）。控制出血和减压性颅骨切开术的手术时间从 99 分钟改善至 54 分钟（<0.001）和从 181 分钟改善至 135 分钟（=0.042）。呼吸机使用时间和 PTD 发生率分别从 6 天减少至 4 天（=0.001）和从 22.2%减少至 8.4%（=0.008）。
在韩国刚刚开设的区域创伤中心实施 PIPS 计划后，创伤患者结局得到改善。需要进一步建立 PIPS 计划，以优化创伤患者的救治。
