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A Trauma Outreach Program Provided by a Level I Trauma Center Is an Effective Way to Initiate Peer Review at Referring Hospitals and Foster Process Improvements

Byrnes, Matthew C. MD; Irwin, Eric MD; Becker, Leslie RN; Thorson, Melissa RN; Beilman, Greg MD; Horst, Patrick BS; Croston, Kevin MD

The Journal of Trauma: Injury, Infection, and Critical Care: April 2010 - Volume 68 - Issue 4 - p 778-782
doi: 10.1097/TA.0b013e3181d4886f
Original Article

Background: The initial care of critically injured patients has profound effects on ultimate outcomes. The “golden hour” of trauma care is often provided by rural hospitals before definitive transfer. There are, however, no standardized methods for providing educational feedback to these hospitals for the purposes of performance improvement. We hypothesized that an outreach program would stimulate peer review and identify systematic deficiencies in the care of patients with injuries.

Methods: We developed a quality improvement program aimed at providing educational feedback to hospitals that referred patients to our American College of Surgeons-verified level I trauma center. We traveled to each referral center to provide feedback on the initial treatment and ultimate outcome of patients that were transferred to us. These feedback sessions were presented in the format of case presentations and case discussions.

Results: The outreach program was presented at each hospital every 3 months to 6 months. Nine hospitals were included in our program. We received 334 patients in transfer from these hospitals during the study period. Formal peer review that focused on trauma patients increased from 14% of hospitals to 100% of hospitals after institution of the program. Eighty-five percent of hospitals thought that the care of patients with injuries was improved as a result of the program. Eighty-five percent of hospitals developed process improvement initiatives as a result of the program.

Conclusions: A formal outreach program can stimulate peer review at rural hospitals, provide continuing education in the care of patients with injuries, and foster process improvements at referring hospitals.

From the Division of Trauma (M.C.B., E.I., L.B., M.T., K.C.), Department of Surgery, North Memorial Trauma Institute, North Memorial Medical Center, Robbinsdale, Minnesota; and Division of Surgical Critical Care (M.C.B., G.B., P.H.), University of Minnesota, Minneapolis, Minnesota.

Submitted for publication March 6, 2009.

Accepted for publication January 15, 2010.

Presented at the 39th Annual Meeting of the Western Trauma Association, February 22–28, 2009, Crested Butte, Colorado.

Address for reprints: Matthew C. Byrnes, MD, Division of Surgical Critical Care, University of Minnesota, MMC 11, 420 Delaware Street SE, Minneapolis, MN 55455; email:

© 2010 Lippincott Williams & Wilkins, Inc.