Major differences in trauma care between hospitals in Sweden: a preliminary report.

The quality of trauma care has been studied at five different Swedish hospitals. The results suggest that improvements in the quality of medical care for patients with severe road traffic injuries can be achieved by reorganizing the highly decentralized trauma care system in Sweden. Above all there is a need for a better structure and organization of the on-call system and of the cooperation of physicians of different specialties within the hospital. The medical care of patients with severe injuries was delayed in 30% and was inappropriate in 7% of cases. Assessment of the quality showed great variation between the hospitals. The medical care was in fact not best at the university hospital but at one well-functioning small hospital. It was an effect of an on-call system at the small hospital, which guarantees rapid participation of senior staff in both general surgery and orthopaedic surgery. The greatest problems arose in early diagnosis and treatment of bleeding in abdominal injuries. This was caused by inexperience in the first on-call team in combination with late assessment by second on-call consultants. Fractures of the femoral shaft in almost half of the cases did not get definitive surgery until several days after the accident.