Shackford S R, Hollingsworth-Fridlund P, McArdle M, Eastman A B
J Trauma. 1987 Aug;27(8):866-75.
A multidisciplinary concurrent audit of the quality of medical care within a trauma system was carried out by a committee of physicians, nurses, and health officials representing trauma centers, nontrauma hospitals, and the public agency administrating the trauma system. Care was audited with regard to timeliness and appropriateness of diagnosis and therapy. Complications were classified as being due to an error in diagnosis, judgment, or technique. Deaths were classified as nonpreventable, potentially salvageable, or frankly preventable. During the first 22 months of operation (1 August 1984-30 May 1986), 7,936 cases were audited. Of the 224 deaths occurring at nontrauma hospitals, 17 (7.6%) were felt to be frankly preventable. Of 541 deaths occurring at trauma centers, 11 (2.0%) were felt to be frankly preventable (p less than 0.001). The most common problem implicated in preventable deaths at nontrauma center hospitals was an error in diagnosis. Preventable deaths at trauma centers were most commonly due to an error in technique. Complications or protocol violations occurred in 595 of 6,564 surviving trauma patients (9.1%). During the first 12 months of system operation, 7,200 person-hours were required to perform the audit. Personnel costs alone for audit in the first year were $300,420.
一个由代表创伤中心、非创伤医院以及管理创伤系统的公共机构的医生、护士和卫生官员组成的委员会，对创伤系统内的医疗质量进行了多学科同步审计。审计内容包括诊断和治疗的及时性与恰当性。并发症被归类为诊断、判断或技术失误所致。死亡被分为不可预防、可能可挽救或明显可预防。在运营的前22个月（1984年8月1日至1986年5月31日），共审计了7936例病例。在非创伤医院发生的224例死亡病例中，17例（7.6%）被认为是明显可预防的。在创伤中心发生的541例死亡病例中，11例（2.0%）被认为是明显可预防的（p<0.001）。非创伤中心医院可预防死亡中最常见的问题是诊断失误。创伤中心可预防死亡最常见的原因是技术失误。在6564名存活的创伤患者中，595例（9.1%）出现了并发症或违反治疗方案的情况。在系统运营的前12个月，进行审计需要7200人时。第一年仅审计的人员成本就达300420美元。
