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An Evidence-based, T rauma Quality Improvement Program

An Evidence-based, T rauma Quality Improvement Program. Grant Christey Ballooning Issues 31 March 2014. Reality. Numbers. Time Pre-hospital 2 hours Time in ED = 1.5 hours Time in Hospital = 134 days Operations = 22 Changes of dressings = about 75

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An Evidence-based, T rauma Quality Improvement Program

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  1. An Evidence-based, Trauma Quality Improvement Program Grant Christey Ballooning Issues 31 March 2014

  2. Reality

  3. Numbers • Time Pre-hospital 2 hours • Time in ED = 1.5 hours • Time in Hospital = 134 days • Operations = 22 • Changes of dressings = about 75 • Tracheostomy suctionings = about 140 • Nursing hours 134 days x 4 hrs/d = 536h • Physio hours = 112 days x 2 hrs/d = 224h • Family car expenses to visit = $10,000 • National value of statistical life = $2.8m

  4. Services Involved Occupational Therapy St John Ambulance Emergency Department Anaesthesia ICU/HDU Trauma Service Theatres Cardiothoracic Surgery OrthopaedicSurgery Occupational Therapy Physiotherapy Social Work Pain Service Nutrition Service Psychiatric Liaison Nursing Vascular Surgery Rehab Services Blood Bank Laboratory Police etc

  5. Paradigms • Single organ injury (90%) • Anatomic • Multiple organ system injury (10%) • Physiologic • Anatomic • Social degradation: Family/ Work/ Friends • Emotional / Grief / Loss/ PTSD / Psych • Financial loss • “A New Life’ or ‘The End of Life’

  6. MRTS • Launched in 2010 • Hub and spoke structure • 890,000 population in Midland • Based on Waikato Trauma Service (2006) • Functional unit is nurse-doctor combo • Synchronous clinical work and data collection • 5350 admissions; 4800 patients; 450 majors

  7. Tasks • Understand the complexity of patient needs and address them holistically (well beyond anatomic reconstruction) • Use evidence and best practice to drive system change.

  8. Multiple Stakeholders Visions of Quality • A wide range of firmly held beliefs based on specialised knowledge. • Support is language-dependent • By necessity, MRTS has to cover all the languages • We need to show effectiveness • We are holistic • We need (hard) evidence to gain traction • We have a comprehensive regional registry as our platform for evidence-based change.

  9. be

  10. Outcomes • Overall mortality = 0.7% (MRTS target is <1%) • Mortality in Severely injured (ISS>15) 2006 (estimated) = 15.6% 2012-13 (actual) = 8.4% (MRTS target was < 10%) Total Lives saved – 134 • Length of Stay 2007 (estimated) = 5.6 days 2013 (actual) = 3.8 days

  11. Activity • Midland Trauma Research Centre • University partnership; Multiple stakeholders • Validation studies • Incidence: Paeds, Rural, Ethnicity, Elderly, TBI, Spine.. • Spatial econometrics; ‘Trauma Track’ • Multiple quality audits • Ongoing TQIP development • Collaboration and information sharing

  12. Summary • Trauma QI systems improve outcomes • System change depends on a compelling argument high quality data • Triple Aim provides a conceptual framework • The registry is the core of services and TQIP • Enthusiasm and evidence are a powerful combination! Patients Come First

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