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CLINICAL CASE REVIEW QUALITY ASSESSMENT PREVENTABLE DEATH MODEL

CLINICAL CASE REVIEW QUALITY ASSESSMENT PREVENTABLE DEATH MODEL. Stuart Reynolds, MD. QUALITY ASSURANCE. PHILOSOPHY HOSPITAL REGIONAL. QUALITY ASSESSMENT. QA QI PIC 10 STEP FADE IMPROVE PDCA TQM TQI PI. REALITY. TRAUMA IS SURGICAL DISEASE MULTIDISCIPLINARY MEDICAL PROCESSES.

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CLINICAL CASE REVIEW QUALITY ASSESSMENT PREVENTABLE DEATH MODEL

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  1. CLINICAL CASE REVIEWQUALITY ASSESSMENTPREVENTABLE DEATH MODEL Stuart Reynolds, MD

  2. QUALITY ASSURANCE • PHILOSOPHY • HOSPITAL • REGIONAL

  3. QUALITY ASSESSMENT • QA • QI • PIC • 10 STEP • FADE • IMPROVE • PDCA • TQM • TQI • PI

  4. REALITY • TRAUMA IS • SURGICAL DISEASE • MULTIDISCIPLINARY • MEDICAL • PROCESSES

  5. REALITY • TRAUMA CARE ASSESSMENT • INCLUDES THE SYSTEM • MULTIDISCIPLINARY

  6. QA/QI PROCESS • A TOOL • OPPORTUNITY FOR IMPROVEMENT • BAD APPLES • TEAM • GOOD OUTCOME • BAD OUTCOME

  7. PURPOSE • BLAME---NO • TARGET PHASE, PROVIDER---NO • IMPROVE SYSTEM---YES • IMPROVE PATIENT CARE---YES • COMPARE---YES

  8. FOCI • SYSTEMS ISSUES • PROCESSES • CLINICAL CARE EQUITABLE

  9. HOSPITAL • TRAUMA PROGRAM • AUTHORITY • REGISTRY • IDENTIFIERS/SYSTEM

  10. PREVENTABLE MORTALITY STUDIES • URBAN • AUTOPSY • PANEL

  11. RURAL PREVENTABLE MORTALITY STUDY • URBAN/RURAL • PREVENTABLE MORTALITY • INAPPROPRIATE CARE • RESOURCE UTILIZATION

  12. MONTANA RPMS 1990 • PREVENTABLE 13% • HOSPITAL PREVENTABLE 27% • INAPPROPRIATE CARE ED 68%

  13. MONTANA RPMS 1998 • PREVENTABLE 8% • HOSPITAL PREVENTABLE 15% • INAPPROPIATE CARE ED 40%

  14. INTERESTING FINDINGS • DELAY IN DISCOVERY • LONG TRANSPORT • BLS (VOLUNTEER) PREHOSPITAL • RURAL/URBAN NON-SYSTEM

  15. SCOPE OF STUDY • GEOGRAPHY • TIME FRAME • NUMBER OF DEATHS

  16. PANEL • TRAUMA SURGEONS • EMERGENCY PHYSICIANS • ED NURSING • FLIGHT SERVICE • PREHOSPITAL ALS/BLS • CONSULTANTS • PRIMARY/SECONDARY REVIEWERS

  17. SOURCES OF DATA • DEATH CERTIFICATE • AMBULANCE TRIP REPORT • HOSPITAL MEDICAL RECORD • AUTOPSY REPORT • INVESTIGATIVE REPORTS CORONER LAW ENFORCEMENT FARS

  18. CHALLENGES • DIVERGENT DATA SOURCES • INCONSISTENT COMPLETENESS AND ACCURACY • VOLUNTARY DATA SUBMISSION • CONFIDENTIALITY CONCERNS • DESIGN REQUIREMENTS

  19. CHART REVIEW PROCESS • NOT DOCUMENTED, NOT DONE • DOCUMENTED • DX • SEQUENCE • AVOID TUNNEL VISION • NO PREJUDICE • SYSTEMATIC

  20. ABSTRACTS/CHECK LIST • GLOBAL VIEW • DECISIONS REGARDING CARE • AFTER COMPLETE REVIEW

  21. DATA SOURCES • REGISTRY • TRAFFIC REPORTS • CORONER REPORT • AUTOPSY

  22. PREHOSPITAL EMS • TIMES • EVALUATION • INTERVENTIONS/PROTOCOLS • NARRATIVES • INTERHOSPITAL TRANSFER

  23. ED TRAUMA FLOW SHEET • THE IDEAL • RESPONSE/RX TIMES • DIAGNOSTIC TESTS • INTERVENTIONS • SEQUENCE

  24. HOSPITAL RECORDS • H&P • CONSULTATIONS • NURSING NOTES NARRATIVE MIS • DISCHARE SUMMARY

  25. OR RECORD/OP REPORT • TIMES • PROCEDURES • VITAL SIGNS/INITIAL OPERATION • NUMBER/TIMING OF OPERATIONS

  26. INTENSIVE CARE UNIT • APPROPRIATE RX/MONITORING • WHO CARES FOR THE PATIENT

  27. ANCILLARY • APPROPRIATE STUDIES • APPROPRIATE RESPONSE • QUALITY/TIMELINESS OF REPORTS

  28. PREVENTABILITY • ACS GUIDELINES • FRANKLY PREVENTABLE • POSSIBLY PREVENTABLE • NON PREVENTABLE

  29. CARE INAPPROPRIATE • ATLS/PHTLS GUIDELINES • ACLS PROTOCOLS • FUTILE RECUSSITATION

  30. RESOURCE UTILIZATION • PRESERVE SYSTEM RESPONSE • INAPPROPRIATE COST

  31. PREVENTABLE DEATH STUDIES • REGIONAL/STATE • NATIONAL GUIDELINES • SYSTEM FUNCTION • NOT PUNATIVE

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