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Quality of Trauma Care: Is Your Skin in the Game?
Richard Dutton, MD, MBA Former Chief, Trauma Anesthesiology Division and Physician Director of Quality Management R Adams Cowley Shock Trauma Center a Former Executive Director, Anesthesia Quality Institute Chief Quality Officer, United States Anesthesia Partners Richard Dutton, MD, MBA Former Chief, Trauma Anesthesiology Division and Physician Director of Quality Management R Adams Cowley Shock Trauma Center a Former Executive Director, Anesthesia Quality Institute Chief Quality Officer, United States Anesthesia Partners
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I am not Rick!
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Quality of Trauma Care: Is Your Skin in the Game?
Thomas Grissom, MD, FCCM Associate Professor, Dept of Anesthesiology University of Maryland School of Medicine Division of Trauma Anesthesiology R Adams Cowley Shock Trauma Center
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Maryland EMS System Designated Trauma Centers
3 32 2 159 H T H T 51 23 Baltimore City H 7 T H H S S H T H H S T T H T S H S T S H S S H S S H 160 13 116 H T T Designated Trauma Centers Specialty Referral Centers Hospitals Central Alarms EMSTel Telephone Network Medical Command Consultation Centers S H
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Team-Based Care
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Team-Based Care
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The Quality Triangle Process Risk Factors Outcomes
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Good quality! Bad quality!
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Why do patients die? J Trauma 69(3):620-6, 2010
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Median time to death from acute hemorrhage is 2 hours
When do they die? Median time to death from acute hemorrhage is 2 hours % still alive Hours to death Dutton: J Trauma 2010:69:220
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Monthly Quality Report
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Monthly Quality Report
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Monthly Quality Report
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Bypass FY ‘97: 251 Bypass FY ‘98: 97 Bypass FY ‘99: 102 Bypass FY ‘00: 9 Bypass FY ‘01: 2 Bypass FY ’02: 2 Bypass FY ’03: 3 Bypass FY ’04: 4 Bypass FY ’05: 4 Bypass FY ’06: 0
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Outcomes
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Bypass FY ‘97: 251 Bypass FY ‘98: 97 Bypass FY ‘99: 102 Bypass FY ‘00: 9 Bypass FY ‘01: 2 Bypass FY ’02: 2 Bypass FY ’03: 3 Bypass FY ’04: 4 Bypass FY ’05: 4 Bypass FY ’06: 0
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Outcomes: Trauma center availability
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Outcomes: Unexpected readmissions
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Outcomes: Effort expended
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Emergency laparotomy pathway quality improvement care (ELPQuiC)
Initial assessment with early warning scores Early antibiotics Interval between decision and operation less than 6 hrs Goal directed fluid therapy Postoperative intensive care Implemented in four centers in the UK
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