Trauma Center, Peking University People's Hospital, Beijing, 100044, China.
BMC Emerg Med. 2022 Mar 5;22(1):34. doi: 10.1186/s12873-022-00595-8.
This study aimed to review the impact of quality control management on the treatment of severely injured patients.
A retrospective analysis was conducted on patients with severe injury (injury severity score [ISS] ≥ 16) between January 1, 2018 and February 1, 2020. The selected patients were stratified as follows. The patients who were admitted prior to the implementation of quality control management-from January 1 to December 31, 2018-were assigned to the PRE group; the POST group included patients who were admitted after the implementation-from February 1, 2019 to February 1, 2020. Quality control management was implemented from January 1, 2019 to January 31, 2019. Parameters were compared to account for differences in terms of demographics, surgical procedures, results of process quality, and 72-h mortality.
This study included 599 patients (PRE group: 212 males and 86 females; POST group: 228 males and 73 females; P = 0.20). The extent of document completion was 97.3 and 100% in the PRE and POST groups, respectively (P < 0.001). There was no delay in the arrival of the trauma surgeons or the multidisciplinary team after implementation. However, following implementation of quality control management, there was a significant reduction in the duration of basic diagnostics, time until receipt of laboratory data, time until first computed tomography scan, time until intubation, and time until an emergency operation (P < 0.05). The deaths were caused by severe head injury (PRE: 5.4%, POST: 4%), hemorrhagic shock (PRE: 2.4%, POST: 0.7%), multiple-organ failure (PRE: 1.0%, POST: 0.3%), or other causes (PRE: 0.7%, POST: 0.0%). The 72-h mortality decreased after the implementation of quality control management (PRE vs. POST groups: 9.4 vs. 5.0%, P = 0.04).
The implementation of quality control management resulted in decreased time to critical interventions, improved patient care efficiency, and reduced early mortality. We recommend that this approach be replicated at other trauma centers in China.
本研究旨在回顾质量控制管理对严重创伤患者治疗的影响。
对 2018 年 1 月 1 日至 2020 年 2 月 1 日期间收治的严重创伤患者（损伤严重程度评分[ISS]≥16）进行回顾性分析。将入选患者分为以下两组。质量控制管理实施前（2018 年 1 月 1 日至 12 月 31 日）收治的患者归入 PRE 组；质量控制管理实施后（2019 年 2 月 1 日至 2020 年 2 月 1 日）收治的患者归入 POST 组。质量控制管理于 2019 年 1 月 1 日至 1 月 31 日实施。比较两组患者的人口统计学、手术方式、过程质量结果和 72 h 死亡率等参数。
本研究共纳入 599 例患者（PRE 组：男性 212 例，女性 86 例；POST 组：男性 228 例，女性 73 例；P=0.20）。PRE 组和 POST 组的文件完成度分别为 97.3%和 100%（P＜0.001）。创伤外科医生和多学科团队到达时间无延迟。但实施质量控制管理后，基础诊断时间、实验室数据获取时间、首次计算机断层扫描时间、插管时间和急诊手术时间显著缩短（P＜0.05）。死亡原因分别为严重颅脑损伤（PRE 组：5.4%，POST 组：4%）、失血性休克（PRE 组：2.4%，POST 组：0.7%）、多器官功能衰竭（PRE 组：1.0%，POST 组：0.3%）或其他原因（PRE 组：0.7%，POST 组：0.0%）。实施质量控制管理后，72 h 死亡率降低（PRE 组与 POST 组分别为 9.4%和 5.0%，P=0.04）。
实施质量控制管理可缩短关键干预时间，提高患者救治效率，降低早期死亡率。建议在中国其他创伤中心推广这种方法。
