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Intensive Care Medicine

, Volume 28, Issue 10, pp 1395–1404 | Cite as

A multidisciplinary quality management system for the early treatment of severely injured patients: implementation and results in two trauma centers

  • Steffen Ruchholtz
  • Christian Waydhas
  • Ulrike Lewan
  • Karl Piepenbrink
  • Dietmar Stolke
  • Jörg Debatin
  • Leonhard Schweiberer
  • Dieter Nast-Kolb
Original

Abstract

Objective. The impact of a multidisciplinary quality management system (MQMS) on the early treatment of severely injured patients was tested.

Design and setting. Prospective clinical study in two level 1 trauma centers.

Methods and materials. MQMS comprised a protocol for documentation, 20 assessment criteria, and the judgement of data by a quality circle. After implementation in Munich (1st period, n=90; 2nd period, n=77) the validation took place in Essen (1st period, n=175; 2nd period, n=150).

Results. Improvements in diagnostics were shown by significant time savings in radiological diagnostics and before computed tomography in severe traumatic brain injury. In patients with hemorrhagic shock there was a reduction in time before transfusion (49 to 14 min in Munich; 31 to 22 min in Essen) and before emergency operation (74 to 43 min in Munich; 69 to 45 min in Essen). The time before craniotomy was reduced from 97 to 67 min in Munich. The incidence of delayed diagnosis of life-threatening lesions was diminished from 6% to 3% in Munich (not found in Essen). The TRISS technique showed a reduction in mortality in both hospitals in the second period (Munich: 15.4% TRISS vs. 9.1% observed mortality; Essen: 17.8% vs. 11.3%).

Conclusions. MQMS improved early clinical treatment in severe injury with respect to therapeutic effectiveness and outcome. The effectiveness of the MQMS was shown at two different hospitals

Quality management Early clinical therapy Multiple injuries Severe blunt trauma Penetrating trauma Emergency operation 

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Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Steffen Ruchholtz
    • 1
  • Christian Waydhas
    • 1
  • Ulrike Lewan
    • 1
  • Karl Piepenbrink
    • 2
  • Dietmar Stolke
    • 3
  • Jörg Debatin
    • 4
  • Leonhard Schweiberer
    • 5
  • Dieter Nast-Kolb
    • 1
  1. 1.Department of Trauma Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany
  2. 2.Department of Anesthesiology, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany
  3. 3.Department of Neurosurgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany
  4. 4.Department of Radiology, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany
  5. 5.Department of Surgery, Klinikum Innenstadt, Ludwig Maximilian University of Munich, Munich, Germany

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