Alberts K A, Brismar B, Nygren A
Department of Orthopaedics, Karolinska Hospital, Stockholm, Sweden.
Qual Assur Health Care. 1993 Mar;5(1):13-7. doi: 10.1093/intqhc/5.1.13.
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.
瑞典五家不同医院对创伤护理质量进行了研究。结果表明，通过重组瑞典高度分散的创伤护理系统，可以提高严重道路交通伤患者的医疗护理质量。最重要的是，需要更好地构建和组织值班制度以及医院内不同专科医生之间的合作。重伤患者的医疗护理有30%出现延误，7%的情况不恰当。质量评估显示各医院之间存在很大差异。实际上，大学医院的医疗护理并非最佳，而是一家运作良好的小医院。这是小医院值班制度的效果，该制度保证了普通外科和骨科高级 staff 的快速参与。最大的问题出现在腹部损伤出血的早期诊断和治疗中。这是由于第一值班团队缺乏经验，加上第二值班顾问评估延迟所致。几乎一半病例的股骨干骨折直到事故发生几天后才进行确定性手术。
