RTCC Performance RTCC Performance ImprovementImprovement

South East Regional Trauma Coordinating Committee Meeting

January 9, 2009

Temecula, CA

Trauma Care System Definition

“A trauma care system may be defined as an organized approach to the acutely injured patient that provides personnel, facilities,and equipment for optimal care on an emergency basis within a defined geographic area.”

Maull, K., Esposito, T.

Historical Perspective

Shift scope of management– Individual patient,

hospital based approach

– Organized regional/system approach

System Continuum Components

Prehospital care In-hospital careRehabilitationResearch driven quality assurance

Goals of Trauma System

Right patientRight facilityRight time frame

Basis for Regionalization

Maximize efficiencies Pool resources Optimize outcomes

– Decrease mortality– Decrease morbidity

Reduce costs

Trauma System Components

“Inclusive System” ( HRSA) Public Information, education, injury prevention Human Resources Prehospital care

– Communications– Medical Direction– Triage– Transport

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

Trauma System Components

Interfacility transfer Rehabilitation System Evaluation Research

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

Systems Process Improvement

Identify Challenges Develop process indicators Approach

– Must fit environment– Cannot be one size fits all – Must be measurable– Must be meaningful

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

Special Considerations

Pediatrics Geriatric care Disaster preparedeness

– Mass casualty response– Coordination of resources

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

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

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

System Wide QA and Evaluation

Standardized Data Collection is Key

Consider Compliance with CEMSIS Trauma Data Dictionary (NTDS-based)

Standardized Mortality Definitions

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

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

Opportunities and Challenges Opportunities and Options

– Use previously developed programs– Home grown

Indicators for QA and PI Surveillance tools Accountability Authority Tracking Tools

Discussion and Questions?Placer

Yolo

SutterEl Dorado

Santa Clara Merced

Mariposa

Madera

SanBenito

Monterey

FresnoInyo

Kings

Tulare

KernSan LuisObispo

Santa Barbara

Ventura Los Angeles

San Bernardino

RiversideOrange

San Diego Imperial

DelNorte

Siskiyou Modoc

HumboldtTrinity Shasta Lassen

TehamaPlumas

Mendocino GlennButte

Sierra

NevadaYuba

Colusa

Lake

SonomaNapa Alpine

AmadorSolano

Contra Costa

Calaveras

Tuolumne Mono

Marin

San FranciscoAlameda StanislausSan

Mateo

SantaCruz

Sac

San Joaquin