CLINICAL CASE REVIEW QUALITY ASSESSMENT PREVENTABLE DEATH MODEL Stuart Reynolds, MD

QUALITY ASSURANCE PHILOSOPHY HOSPITAL REGIONAL

QUALITY ASSESSMENT QA QA QI QI PIC PIC 10 STEP 10 STEP FADE FADE IMPROVE IMPROVE PDCA PDCA TQM TQM TQI TQI PI PI

REALITY TRAUMA IS SURGICAL DISEASE MULTIDISCIPLINARY MEDICAL PROCESSES

REALITY TRAUMA CARE ASSESSMENT INCLUDES THE SYSTEM MULTIDISCIPLINARY

QA/QI PROCESS A TOOL OPPORTUNITY FOR IMPROVEMENT BAD APPLES TEAM GOOD OUTCOME BAD OUTCOME

PURPOSE BLAME---NO TARGET PHASE, PROVIDER---NO IMPROVE SYSTEM---YES IMPROVE PATIENT CARE---YES COMPARE---YES

FOCI SYSTEMS ISSUES PROCESSES CLINICAL CARE EQUITABLE

HOSPITAL TRAUMA PROGRAM AUTHORITY REGISTRY IDENTIFIERS/SYSTEM

PREVENTABLE MORTALITY STUDIES URBAN AUTOPSY PANEL

RURAL PREVENTABLE MORTALITY STUDY URBAN/RURAL PREVENTABLE MORTALITY INAPPROPRIATE CARE RESOURCE UTILIZATION

MONTANA RPMS 1990 PREVENTABLE 13% HOSPITAL PREVENTABLE 27% INAPPROPRIATE CARE ED 68%

MONTANA RPMS 1998 PREVENTABLE 8% HOSPITAL PREVENTABLE 15% INAPPROPIATE CARE ED 40%

INTERESTING FINDINGS DELAY IN DISCOVERY LONG TRANSPORT BLS (VOLUNTEER) PREHOSPITAL RURAL/URBAN NON-SYSTEM

SCOPE OF STUDY GEOGRAPHY TIME FRAME NUMBER OF DEATHS

PANEL TRAUMA SURGEONS EMERGENCY PHYSICIANS ED NURSING FLIGHT SERVICE PREHOSPITAL ALS/BLS CONSULTANTS PRIMARY/SECONDARY REVIEWERS

SOURCES OF DATA DEATH CERTIFICATE AMBULANCE TRIP REPORT HOSPITAL MEDICAL RECORD AUTOPSY REPORT INVESTIGATIVE REPORTS CORONER LAW ENFORCEMENT FARS

CHALLENGES DIVERGENT DATA SOURCES INCONSISTENT COMPLETENESS AND ACCURACY VOLUNTARY DATA SUBMISSION CONFIDENTIALITY CONCERNS DESIGN REQUIREMENTS

CHART REVIEW PROCESS NOT DOCUMENTED, NOT DONE DOCUMENTED  DX  SEQUENCE AVOID TUNNEL VISION NO PREJUDICE SYSTEMATIC

ABSTRACTS/CHECK LIST GLOBAL VIEW DECISIONS REGARDING CARE – AFTER COMPLETE REVIEW

DATA SOURCES REGISTRY TRAFFIC REPORTS CORONER REPORT AUTOPSY

PREHOSPITAL EMS TIMES EVALUATION INTERVENTIONS/PROTOCOLS NARRATIVES INTERHOSPITAL TRANSFER

ED TRAUMA FLOW SHEET THE IDEAL RESPONSE/RX TIMES DIAGNOSTIC TESTS INTERVENTIONS SEQUENCE

HOSPITAL RECORDS H&P CONSULTATIONS NURSING NOTES NARRATIVE MIS DISCHARE SUMMARY

OR RECORD/OP REPORT TIMES PROCEDURES VITAL SIGNS/INITIAL OPERATION NUMBER/TIMING OF OPERATIONS

INTENSIVE CARE UNIT APPROPRIATE RX/MONITORING WHO CARES FOR THE PATIENT

ANCILLARY APPROPRIATE STUDIES APPROPRIATE RESPONSE QUALITY/TIMELINESS OF REPORTS

PREVENTABILITY ACS GUIDELINES – FRANKLY PREVENTABLE – POSSIBLY PREVENTABLE – NON PREVENTABLE

CARE INAPPROPRIATE ATLS/PHTLS GUIDELINES ACLS PROTOCOLS FUTILE RECUSSITATION

RESOURCE UTILIZATION PRESERVE SYSTEM RESPONSE INAPPROPRIATE COST

PREVENTABLE DEATH STUDIES REGIONAL/STATE NATIONAL GUIDELINES SYSTEM FUNCTION NOT PUNATIVE