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Trauma Center Quality Improvement Programs in the United States, Canada, and Australasia

Stelfox, Henry T. MD, PhD, FRCPC*; Straus, Sharon E. MD, MSc, FRCPC; Nathens, Avery MD, PhD, FRCSC§; Gruen, Russell L. MBBS, PhD, FRACS; Hameed, Syed M. MD, MPH, FRCSC; Kirkpatrick, Andrew MD, MSc, FRCSC

doi: 10.1097/SLA.0b013e318256c20b
Original Articles

Objective: To compare quality improvement (QI) programs of trauma centers in 4 high-income countries.

Background: Injury is a leading cause of morbidity and mortality in countries around the world, but patient outcomes vary among countries with similar systems of trauma care.

Methods: We surveyed medical directors and program managers from 330 trauma centers verified by professional trauma organizations in the United States (n = 263), Canada (n = 46), and Australasia (Australia, n = 18; New Zealand, n = 3) regarding their QI programs. Quality indicators were requested from all centers that measured quality of care. Follow-up interviews were performed with 75 centers purposively sampled across 6 baseline criteria.

Results: A total of 251 centers (76% response rate) responded to the survey, with a similar distribution across countries. Trauma centers in the United States were more likely than those in Canada and Australasia to report measuring quality indicators (100% vs 94% vs 93%, P = 0.008), using report cards (53% vs 33% vs 31%, P = 0.033) and benchmarking (81% vs 61% vs 69%, P = 0.019). Centers in all 3 regions primarily used hospital process and outcome measures designed to establish whether care was safe (98% vs 97% vs 75%, P = 0.008), effective (97% vs 97% vs 92% P = 0.399), timely (88% vs 100% vs 92%, P = 0.055), and efficient (95% vs 100% vs 83%, P = 0.082). QI programs were largely local in nature, used different criteria to identify patients under QI purview, and employed diverse quality indicators and improvement strategies. Few centers evaluated the effectiveness of their QI program.

Conclusions: This study provides the first international comparison of trauma center QI programs and demonstrates broad implementation in verified trauma centers in the United States, Canada, and Australasia. Significant variation exists in how trauma centers perform QI activities. Opportunities exist for improving and standardizing QI processes.

Supplemental Digital Content is Available in the Text.This study compares quality improvement programs of trauma centers in the United States, Canada, Australia, and New Zealand. Quality improvement programs were largely local in nature, used different criteria to identify patients under purview, and employed diverse quality measurement and improvement strategies. Opportunities exist for improving and standardizing quality improvement processes.

*Departments of Critical Care Medicine, Medicine and Community Health Sciences

Departments of Surgery and Critical Care Medicine, University of Calgary, Canada

Department of Medicine

§Department of Surgery, Division of Trauma, Saint Michael's Hospital, University of Toronto, Canada

The National Trauma Research Institute, The Alfred, Monash University, Melbourne, Australia

Vancouver General Hospital, Department of Surgery, University of British Columbia, Canada.

Reprints: Henry T. Stelfox, MD, PhD, FRCPC, Teaching Research & Wellness Building, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6, Canada. E-mail: tstelfox@ucalgary.ca.

Disclosure: The project was supported by a partnership in Health System Improvement Grant (PHE-91429) from the Canadian Institutes of Health Research and Alberta Innovates. H.T.S. is supported by a New Investigator Award from the Canadian Institutes of Health Research and a Population Health Investigator Award from Alberta Innovates. The authors declare that funding sources had no role in the design, conduct, or reporting of this study and they are unaware of any conflicts of interest. None of the authors have financial or professional conflicts of interest that would influence the conduct or reporting of this study. H.T.S. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

© 2012 Lippincott Williams & Wilkins, Inc.