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In order to promote greater implementation of effective, affordable and sustainable trauma systems globally, the World Health Organization and the International Association for Trauma Surgery and Intensive Care have worked collaboratively to produce these guidelines on trauma quality improvement. The response to the growing problem of injury needs to include the improvement of care of the injured. Quality improvement (QI) programs offer an affordable and sustainable means to implement such improvements. These programs enable health care institutions to better monitor trauma care services, better detect problems in care, and more effectively enact and evaluate corrective measures targeted at these problems. The goal of this publication is to give guidance on ways in which health care institutions globally can implement QI programs oriented to strengthening care of the injured. This guidance is intended to be universally applicable to all countries, no matter what their economic level. These guidelines provide basic definitions and an overview of the field of QI, so that those not familiar with this field will have a working knowledge of it. Evidence of the benefit of QI in general and trauma QI in particular is then laid out. The main part of the publication reviews the most common methods of trauma QI, written in a how-do-to fashion. This covers a wide range of techniques. The first two of these are especially emphasized as ways in which to strengthen trauma QI in the setting of low-income and middle-income countries.
Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events. Intentional steps to codify and harvest the lessons learned within the military's trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost. A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military's experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system.
Managing a trauma center involves complex clinical care, long nights and days, administrative work, self-examination, critical review of patient care and significant regulatory requirements. Performance improvement is the key element of trauma center effectiveness. No trauma center provides flawless care, thus all centers have opportunities to improve. A competent performance improvement program is critical to trauma center outcomes. This book provides key information on all aspects of trauma PI and program management. In some ways, PI is an art more than a science, so the more interaction program leaders have with strong PI programs, the more they can learn about how to improve their processes. The book outlines the generally accepted processes for identification of opportunities for improvement, which are the key component of performance improvement. This includes: rounding with care teams, contemporaneous chart review, audit filters, and voluntary submissions to the trauma program for review. This book explains how to triage opportunities for improvement, analyze them, form corrective actions, and finally achieve loop closure. The book covers the roles of the personnel in the PI program, what is required to dissect the opportunity to determine action plans, how to document the entire process, and how to keep track of opportunities for improvement to ensure that your program is progressively improving care. The final sections of the book deal with specific opportunities for improvement, action plans, and loop closure through the use of case studies. The book serves as a follow-up to Dr. Jeffrey Young’s recently published book Trauma Centers, which serves as a quick guide to the key components of trauma center administration, management, and patient care.
Injuries are the leading cause of death and disability among people under age 35 in the United States. Despite great strides in injury prevention over the decades, injuries result in 150,000 deaths, 2.6 million hospitalizations, and 36 million visits to the emergency room each year. Reducing the Burden of Injury describes the cost and magnitude of the injury problem in America and looks critically at the current response by the public and private sectors, including: Data and surveillance needs. Research priorities. Trauma care systems development. Infrastructure support, including training for injury professionals. Firearm safety. Coordination among federal agencies. The authors define the field of injury and establish boundaries for the field regarding intentional injuries. This book highlights the crosscutting nature of the injury field, identifies opportunities to leverage resources and expertise of the numerous parties involved, and discusses issues regarding leadership at the federal level.
Injury is an increasingly significant health problem throughout the world, accounting for 16 per cent of the global burden of disease. The public health burden of death and disability from injury is particularly notable in low and middle income countries. These guidelines seek to establish practical and affordable standards applicable to injury or trauma care worldwide, whether in rural health posts, small hospitals, hospitals staffed by specialists or tertiary care centres. It sets out a list of key trauma treatment services designed to be achievable in all settings, and defines the various human and physical resources required. It also includes a number of recommendations for methods to promote such standards including training, performance improvement, trauma team organisation and hospital inspection.
Offering expert, comprehensive guidance on the basic science, diagnosis, and treatment of acute musculoskeletal injuries and post-traumatic reconstructive problems, Skeletal Trauma, 6th Edition, brings you fully up to date with current approaches in this challenging specialty. This revised edition is designed to meet the needs of orthopaedic surgeons, residents, fellows, and traumatologists, as well as emergency physicians who treat patients with musculoskeletal trauma. International thought leaders incorporate the latest peer-reviewed literature, technological advances, and practical advice with the goal of optimizing patient outcomes for the full range of traumatic musculoskeletal injuries. Offers complete coverage of relevant anatomy and biomechanics, mechanisms of injury, diagnostic approaches, treatment options, and associated complications. Includes eight new chapters dedicated to advances in technology and addressing key problems and procedures, such as Initial Evaluation of the Spine in Trauma Patients, Management of Perioperative Pain Associated with Trauma and Surgery, Chronic Pain Management (fully addressing the opioid epidemic), Understanding and Treating Chronic Osteomyelitis, and more. Features a complimentary one-year subscription to OrthoEvidence, a global online platform that provides high-quality, peer-reviewed and timely orthopaedic evidence-based summaries of the latest and most relevant literature. Contains unique, critical information on mass casualty incidents and war injuries, with contributions from active duty military surgeons and physicians in collaboration with civilian authors to address injuries caused by road traffic, armed conflict, civil wars, and insurgencies throughout the world. Features important call out boxes summarizing key points, pearls and pitfalls, and outcomes. Provides access to nearly 130 instructional videos that demonstrate principles of care and outline detailed surgical procedures. Contains a wealth of high-quality illustrations, full-color photographs, and diagnostic images.
Injuries are one of the most serious public health problems facing the United States today. Through premature death, disability, medical cost and lost productivity, injuries impact the health and welfare of all Americans. Deaths only begin to tell the story. Although many injuries are minor, a large proportion result in fractures, amputations, burns, or other significant injuries that have far-reaching consequences. Now, for the first time in over 15 years, we have comprehensive estimates of the impact of these injuries in economic terms. This book updates a landmark Report to Congress from 1989. Since the report, no undertaking has addressed the incidence and economic burden of injuries with more timely data, despite major changes in the fields of prevention, reporting, and surveillance. Since the mid-eighties, new safety technologies have been developed to prevent injuries or to decrease the severity of injuries, and new policies and laws have been enacted to promote injury prevention. Chapter topics include incidence by detailed categorizations, lifetime medical costs and productivity losses as a result of injuries, and a discussion of recent trends. Lavishly illustrated with tables and graphs, this volume is a valuable reference for public health practitioners, researchers, and students alike.