trauma centre accreditation as a tool for focused ... podium 1 ql mspp v2.0 trauma centre...lessons...
TRANSCRIPT
René Grobler Mariesa Human
Netcare Milpark Hospital
Trauma Centre Accreditation as a Tool for
Focused Performance Improvement
Introduction Netcare Milpark Hospital was accredited as the first private Level I Trauma Centre in SA by the Trauma Society of South Africa (TSSA)
in March 2011 and re-verified as a Level I Trauma Centre in February 2014.
Problem: • We continuously aim to improve the outcome of our trauma (injured)
patients. • Compliance to specific international benchmark standards for time
management is essential in ensuring improved patient outcomes. • Monitoring and peer review processes were started as part of the
weekly Trauma Outcome Review (TOR) meetings and monthly Trauma Morbidity & Mortality and Trauma Programme meetings.
Aim of Performance Improvement Focus
According to Guidelines of Trauma Centres – TSSA & Resources for Optimal Care of the Injured Patient
(American College of Surgeons):
• Response Times of Trauma Surgeons: (≤ 10 minutes) • Resuscitation Times – start of resuscitation efforts to the end of the
primary survey: (≤ 30 minutes) • Total Resuscitation Times – start of resuscitation efforts to the time
the patient leave the Emergency Department: (≤60 minutes).
Strategy for Change
• The relevant times were documented on the P1 Resuscitation document,
• But no platform for evaluation and review as part of a continuous performance improvement focus.
Improvement of
Resuscitation Times
Arrival of Injured Patient
Documentation of Times on P1
Medibank Document
Review of Times during
TOR meetings
Peer Review during M&M and Trauma Managenent
Meetings
Improvment of Resuscitation
Times
Improved Patient
Outcomes
P-‐D-‐S-‐A CY
CLE
Implementation and Evaluation
Arrival of Injured Patient
Trauma Team Activation
Response Times of Trauma Surgeons (≤ 10 minutes)
Resuscitation Times (≤ 30 minutes)
Total Resuscitaion Times ( ≤ 60 minutes )
Improved Resuscitation Times
Improved Patient Outcomes
Evalua
/ons during TO
R; M
&M M
ee/n
gs
Introd
uc/o
n of clocks F
eb 2014
Results: Average Response Times
12
10
6
0
2
4
6
8
10
12
14
2012 2013 2014
Tim
e in
Min
utes
Response Times Goal: ≤ 10 Minutes
Average Response Times for Trauma Surgeons
Goal: 10 Minutes
Results: Resus Times
00:32
00:25 00:24
00:00
00:07
00:14
00:21
00:28
00:36
2012 2013 2014
Tim
e in
Min
utes
Resus Times Goals: ≤ 30 Minutes
Average Resus Times
01:13 01:14
01:06
01:01 01:03 01:04 01:06 01:07 01:09 01:10 01:12 01:13 01:14
2012 2013 2014
Tim
e in
Min
utes
Total Resus Times: ≤ 60 Minutes
Average Total Resus Times
Goal: 30 Minutes
Goal: 60 Minutes
Lessons Learnt & Message to others
Lessons Learnt: Reduction of resuscitation times at Netcare Milpark Level I Trauma Centre through the implementation of the following
– Measurement of Accurate Times: – Activation of countdown clocks upon arrival of the injured patient – Result: accurate documentation and constant focus on the “running” time. – Review Process: – Measurement, evaluation and review of process in order to identify and correct
causes for delay in not achieving goals (times)
Message to others: • Effective monitoring of times in the management of an injured patient has a significant
influence and can improve the outcomes. • Structured PI process (Documentation – TOR – M&M and Trauma Management Review
Meetings) contribute to achieving the improvement of the time standards and thus ultimately improve patient outcomes.