RTCC Performance Improvement

1. RTCC Performance Improvement South East Regional Trauma Coordinating Committee Meeting January 9, 2009 Temecula, CA INTRODUCE SHARON AND SELF. There are persons in this room who have literally written the book on the development and evaluation of trauma systems. Please bear with us as we provide a broad overview of the topic that many of you have heard before but will provide a basis for our discussion later today as we discuss the design of a trauma system quality plan for SE RTCCINTRODUCE SHARON AND SELF. There are persons in this room who have literally written the book on the development and evaluation of trauma systems. Please bear with us as we provide a broad overview of the topic that many of you have heard before but will provide a basis for our discussion later today as we discuss the design of a trauma system quality plan for SE RTCC

2. Trauma Care System Definition We are all familiar with the 1966 white paper on trauma, the report out of the National Academy of Sciences and National Research Council entitled �Accidental Death and Disability: The Neglected Disease of Modern Society. This was a call to action The outgrowth of this paper was the development and propagation of what has now become a standard of care. Much progress has been made since those early days.; Drs Maull and Esposito offered this definition: Read above)We are all familiar with the 1966 white paper on trauma, the report out of the National Academy of Sciences and National Research Council entitled �Accidental Death and Disability: The Neglected Disease of Modern Society. This was a call to action The outgrowth of this paper was the development and propagation of what has now become a standard of care. Much progress has been made since those early days.; Drs Maull and Esposito offered this definition: Read above)

3. Historical Perspective Shift scope of management Individual patient, hospital based approach Organized regional/system approach The regionalization of trauma care over the past 30 years has shifted the scope of the management of trauma patients from a hospital centric to a systems approach. It now consists of a broader or more global approach, from the time of injury to the end of rehabilitation, to repatriation back into the community: hopefully with a return to daily activities. The regionalization of trauma care over the past 30 years has shifted the scope of the management of trauma patients from a hospital centric to a systems approach. It now consists of a broader or more global approach, from the time of injury to the end of rehabilitation, to repatriation back into the community: hopefully with a return to daily activities.

4. System Continuum Components Prehospital care In-hospital care Rehabilitation Research driven quality assurance The regionalized �trauma system� provides a continuum of services encompassing 4 phases of care: (as above) (The regionalized �trauma system� provides a continuum of services encompassing 4 phases of care: (as above) (

5. Goals of Trauma System Right patient Right facility Right time frame We have all heard or recited this mantra throughout our careers. The ultimate goal of these systems is to get the right patient to the right facility inn the right time frame. We have all heard or recited this mantra throughout our careers. The ultimate goal of these systems is to get the right patient to the right facility inn the right time frame.

6. Basis for Regionalization Maximize efficiencies Pool resources Optimize outcomes Decrease mortality Decrease morbidity Reduce costs An integrated system has a variety of advantages compared to a segregated or silo approach to providing trauma care. These advantages have an impact on the processes and the outcomes derived for patients, both short and long term. All aspects of trauma care need to be linked to: (read above) The main purposes of regionalization would be to improve the quality of care and reduce costs. An integrated system has a variety of advantages compared to a segregated or silo approach to providing trauma care. These advantages have an impact on the processes and the outcomes derived for patients, both short and long term. All aspects of trauma care need to be linked to: (read above) The main purposes of regionalization would be to improve the quality of care and reduce costs.

7. Trauma System Components �Inclusive System� ( HRSA) Public Information, education, injury prevention Human Resources Prehospital care Communications Medical Direction Triage Transport From the HRSA :Model Trauma System Planning and Approach. Trauma system components are ideally outlined as an inclusive system to include (read list) From the HRSA :Model Trauma System Planning and Approach. Trauma system components are ideally outlined as an inclusive system to include (read list)

8. Trauma System Components Trauma Care Facilities Level I, II, III, IV Acute care facilities within the system Specialty Trauma Centers Burns Pediatrics Spinal Cord Hand replantation

9. Trauma System Components Interfacility transfer Rehabilitation System Evaluation Research Processes for interfacility transfer Access to rehabilitation Structure and Processes for system evaluation Ongoing research designed to achieve �best practice� Processes for interfacility transfer Access to rehabilitation Structure and Processes for system evaluation Ongoing research designed to achieve �best practice�

10. Trauma System Quality Assurance/ Performance Improvement Importance cannot be overstated Monitor quality of care throughout continuum Establish standards of care Develop surveillance monitors Audit filters; indicators Process for review Documentation Corrective action Uniform application throughout system Reassessment So why have we spent time reviewing all of the elements of a trauma system.? It�s effectiveness needs to be evaluated in an organized manner. This would be done through a Quality Assurance and Performance Improvement framework So why have we spent time reviewing all of the elements of a trauma system.? It�s effectiveness needs to be evaluated in an organized manner. This would be done through a Quality Assurance and Performance Improvement framework

11. Systems Process Improvement Identify Challenges Develop process indicators Approach Must fit environment Cannot be one size fits all Must be measurable Must be meaningful Beyond Quality assurance, which is steeped in the regulatory process, we need to establish a framework for developing and reviewing processes. One example would be around best practices for interfacility transfer. Beyond Quality assurance, which is steeped in the regulatory process, we need to establish a framework for developing and reviewing processes. One example would be around best practices for interfacility transfer.

12. Special Consideration Urban trauma care systems Patient care access Prehospital provider risks Volume Over vs undertriage Rural trauma care systems Transport times Patient care access Resources; facilities and personnel

13. Special Considerations Pediatrics Geriatric care Disaster preparedeness Mass casualty response Coordination of resources

14. Current Programs for System Development and Evaluation Health Resources and Services Administration Model Trauma System Planning and Evaluation (MTSPE) American College of Surgeons Regional Trauma Systems: Optimal Elements, Integration and Assessment

15. ACS System Wide QA & Evaluation Trauma Lead Agency Responsibility Evaluate Effectiveness of injury prevention initiatives Access to care Availability of services Quality of services throughout continuum Prehospital through rehab Community integration Financial impact

16. ACS System Wide QA & Evaluation Delineation of valid objective metrics Ongoing quality audit Patient outcomes Benchmarks Clinical evidence MIS (Trauma Management Information) Support data collection Support data analysis

17. System Wide QA and Evaluation Standardized Data Collection is Key Consider Compliance with CEMSIS Trauma Data Dictionary (NTDS-based) Standardized Mortality Definitions

18. ACS System Wide QA & Evaluation Establish forums for multidisciplinary and multi agency review Evaluation of system integration and effectiveness Customer satisfaction surveys Strategic planning Accountability for achieving defined goals

19. ACS PRQ (Systems) Membership and reporting structure System Integration PI efforts Dispatch,prehospital,TCs, acute care, rehab PI and outcomes measures tracked Includes special populations Specific examples Transport times to definitive care Undertriage rates Overtriage rates

20. Opportunities and Challenges Opportunities and Options Use previously developed programs Home grown Indicators for QA and PI Surveillance tools Accountability Authority Tracking Tools

21. Discussion and Questions?