Format

Send to

Choose Destination
Injury. 2017 Sep;48(9):1985-1993. doi: 10.1016/j.injury.2017.03.003. Epub 2017 Apr 7.

Status of trauma quality improvement programs in the Andean region: What foundation do we have to build on.

Author information

1
University of Washington, Seattle, USA. Electronic address: lagronel@uw.edu.
2
Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: diego.romani.p@upch.pe.
3
Universidad del Azuay, Cuenca, Ecuador. Electronic address: juanfigueroacordero@gmail.com.
4
University of Washington, Seattle, USA. Electronic address: maab@uw.edu.
5
Hospital Nacional Guillermo Almenara, Lima, Peru. Electronic address: edhu562000@gmail.com.
6
Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: manuel.rodriguez@upch.pe.
7
Clinica Foianini, Santa Cruz, Bolivia. Electronic address: efoianini@clinicafoianini.com.
8
Neuroscience Institute, Neurotrauma Group, El Bosque University, Bogotá, Colombia. Electronic address: andresrubiano@aol.com.
9
Universidad del Azuay, Cuenca, Ecuador. Electronic address: ebrodas@gmail.com.
10
University of Washington, Seattle, USA. Electronic address: cmock@uw.edu.

Abstract

INTRODUCTION:

Trauma quality improvement (QI) programs have been shown to improve outcomes and decrease cost. These are high priorities in low- and middle-income countries (LMICs), where 2,000,000 deaths due to survivable injuries occur each year. We sought to define areas for improvement in trauma QI programs in four LMICs.

METHODS:

We conducted a survey among trauma care providers in four Andean middle-income countries: Bolivia, Colombia, Ecuador, and Peru.

RESULTS:

336 physicians, medical students, nurses, administrators and paramedical professionals responded to the cross-sectional survey with a response rate greater than 90% in all included countries except Bolivia, where the response rate was 14%. Eighty-seven percent of respondents reported morbidity and mortality (M&M) conferences occur at their hospital. Conferences were often reported as infrequent - 45% occurred less than every three months and poorly attended - 63% had five or fewer staff physicians present. Only 23% of conferences had standardized selection criteria, most lacked documentation - notes were taken at only 35% of conferences. Importantly, only 13% of participants indicated that discussions were routinely followed-up with any sort of corrective action. Multivariable analysis revealed the presence of standardized case selection criteria (OR 3.48, 95% CI 1.16-10.46), written documentation of the M&M conferences (OR 5.73, 95% CI 1.73-19.06), and a clear plan for follow-up (OR 4.80, 95% CI 1.59-14.50) to be associated with effective M&M conferences. Twenty-two percent of respondents worked at hospitals with a trauma registry. Fifty-two percent worked at institutions where autopsies were conducted, but only 32% of those reported the autopsy results to ever be used to improve hospital practice.

CONCLUSIONS:

M&M conferences are frequently practiced in the Andean region of Latin America but often lack methodologic rigor and thus effectiveness. Next steps in the maturation of QI programs include optimizing use of data from autopsies and registries, and systematic follow-up of M&M conferences with corrective action to ensure that these activities result in appreciable changes in clinical care.

KEYWORDS:

Latin America; Morbidity and mortality meeting; Quality improvement; Registry; Surgery; Trauma

PMID:
28476355
PMCID:
PMC5562511
DOI:
10.1016/j.injury.2017.03.003
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center