This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Indicators of the quality of trauma care and the performance of trauma systems. BJS 2012; 99: 97-104.
Published: 22nd December 2011
Authors: R. L. Gruen, B. J. Gabbe, H. T. Stelfox, P. A. Cameron
Background
Valid and reliable measures of trauma system performance are needed to guide improvement activities, benchmarking and public reporting, future investment and research. Traditional measures of in‐hospital mortality fail to take into account prehospital and posthospital care, recovery after discharge, and the nature and costs of long‐term disability.
Method
Drawing on recent systematic reviews, an overview was conducted of existing and emerging trauma care performance indicators. Changes in the nature and purpose of indicators were assessed.
Results
Among a large number of existing, mostly locally developed performance indicators, only peer review of deaths has evidence of validity or reliability. The usefulness of the traditional performance measure of in‐hospital mortality has been challenged. There is an emerging shift in focus from mortality to non‐mortality outcomes, from hospital‐based to long‐term community‐based outcome assessment, and from single measures of trauma centre performance to measures better suited to monitoring the performance of systems of care spanning the entire patient journey. As a result, a new generation of indicators is emerging that are both feasible and potentially more useful for commissioners and payers of population‐based services.
Conclusion
A global endeavour is now under way to agree on a set of standardized performance indicators that are meaningful to patients, carers, clinicians, managers and service funders, are likely to contribute to desired outcomes, and are valid, reliable and have a strong evidence base. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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