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RTCC Performance Improvement

RTCC Performance Improvement. South East Regional Trauma Coordinating Committee Meeting January 9, 2009 Temecula, CA. Trauma Care System Definition.

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RTCC Performance Improvement

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  1. RTCC Performance Improvement South East Regional Trauma Coordinating Committee Meeting January 9, 2009 Temecula, CA

  2. 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.

  3. Historical Perspective • Shift scope of management • Individual patient, hospital based approach • Organized regional/system approach

  4. System Continuum Components • Prehospital care • In-hospital care • Rehabilitation • Research driven quality assurance

  5. Goals of Trauma System • Right patient • Right facility • Right time frame

  6. Basis for Regionalization • Maximize efficiencies • Pool resources • Optimize outcomes • Decrease mortality • Decrease morbidity • Reduce costs

  7. Trauma System Components • “Inclusive System” ( HRSA) • Public Information, education, injury prevention • Human Resources • Prehospital care • Communications • Medical Direction • Triage • Transport

  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

  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

  11. Systems ProcessImprovement • Identify Challenges • Develop process indicators • Approach • Must fit environment • Cannot be one size fits all • Must be measurable • Must be meaningful

  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. Del Norte Siskiyou Modoc Shasta Trinity Lassen Humboldt Tehama Plumas Butte Mendocino Glenn Sierra Nevada Colusa Yuba Placer Lake Sutter El Dorado Sonoma Yolo Napa Alpine Sac Amador Solano Calaveras Marin San Joaquin Contra Costa Tuolumne Mono San Francisco Alameda Stanislaus Mariposa San Mateo Santa Clara Merced Santa Cruz Madera Fresno San Benito Inyo Tulare Monterey Kings San Luis Obispo Kern San Bernardino Santa Barbara Los Angeles Ventura Orange Riverside Imperial San Diego Discussion and Questions?

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