Intervention Review

Audit filters for improving processes of care and clinical outcomes in trauma systems

  1. Christopher Evans1,*,
  2. Daniel Howes1,
  3. William Pickett2,
  4. Luigi Dagnone1

Editorial Group: Cochrane Injuries Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 20 MAY 2009

DOI: 10.1002/14651858.CD007590.pub2


How to Cite

Evans C, Howes D, Pickett W, Dagnone L. Audit filters for improving processes of care and clinical outcomes in trauma systems. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007590. DOI: 10.1002/14651858.CD007590.pub2.

Author Information

  1. 1

    Queen's University, Department of Emergency Medicine, Kingston, Ontario, Canada

  2. 2

    Queen's University, Department of Community Health and Epidemiology, Kingston, Ontario, Canada

*Christopher Evans, Department of Emergency Medicine, Queen's University, Empire 3, Kingston General Hospital, 76 Stuart St., Kingston, Ontario, K7L 2V7, Canada. 9ce2@queensu.ca.

Publication History

  1. Publication Status: New
  2. Published Online: 7 OCT 2009

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Traumatic injuries represent a considerable public health burden with significant personal and societal costs. The care of the severely injured patient in a trauma system progresses along a continuum that includes numerous interventions being provided by a multidisciplinary group of healthcare personnel. Despite the recent emphasis on quality of care in medicine, there has been little research to direct trauma clinicians and administrators on how optimally to monitor and improve upon the quality of care delivered within a trauma system. Audit filters are one mechanism for improving quality of care and are defined as specific clinical processes or outcomes of care that, when they occur, represent unfavorable deviations from an established norm and which prompt review and feedback. Although audit filters are widely utilized for performance improvement in trauma systems they have not been subjected to systematic review of their effectiveness.

Objectives

To determine the effectiveness of using audit filters for improving processes of care and clinical outcomes in trauma systems.

Search methods

Our search strategy included an electronic search of the Cochrane Injuries Group Specialized Register, the Cochrane EPOC Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 4), MEDLINE, PubMed, EMBASE, CINAHL, and ISI Web of Science: (SCI-EXPANDED and CPCI-S). We handsearched the Journal of Trauma, Injury, Annals of Emergency Medicine, Academic Emergency Medicine, and Injury Prevention. We searched two clinical trial registries: 1) The World Health Organization International Clinical Trials Registry Platform and, 2) Clinical Trials.gov. We also contacted content experts for further articles. The most recent electronic search was completed in December 2008 and the handsearch was completed up to February 2009.

Selection criteria

We searched for randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series studies that used audit filters as an intervention for improving processes of care, morbidity, or mortality for severely injured patients.

Data collection and analysis

Two authors independently screened the search results, applied inclusion criteria, and extracted data.

Main results

There were no studies identified that met the inclusion criteria for this review.

Authors' conclusions

We were unable to identify any studies of sufficient methodological quality to draw conclusions regarding the effectiveness of audit filters as a performance improvement intervention in trauma systems. Future research using rigorous study designs should focus on the relative effectiveness of audit filters in comparison to alternative quality improvement strategies at improving processes of care, functional outcomes, and mortality for injured patients.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Audit filters for improving trauma care

Major injuries are a significant cause of death and decreased quality of life worldwide. Previous research has shown that when severely injured patients are managed in an organized system of care that includes treatment by paramedics, transportation to a hospital that has specialist doctors available to treat their injuries, and additional health personnel to help them to rehabilitate, patients are more likely to survive and suffer fewer disabilities.

There are a number of ways that the quality of care provided to injured patients in a trauma system can be determined and improved. Trauma audit filters are descriptions of specific actions that should be taken, timeframes in which tests or treatments should be provided, or outcomes that are expected to occur in injured patients. Reviewing the charts of patients whose care deviates from that described by an audit filter and providing feedback to the clinicians involved in that patient's care is expected to provide a means of correcting errors and improving future performance.

Our study tried to determine how effective audit filters are at improving trauma care.

We were unable to find any studies to include in the review. More studies are needed to determine if audit filters are effective in improving care and, if they are, how effective they are in comparison to other quality improvement strategies.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

外傷系統中用來改善照護過程與臨床結果的稽核關卡

外傷佔了相當大的公共衛生負擔,包括高額的個人與社會成本。外傷系統中照護嚴重受傷的病患是朝向連續性的照護方式進行,包括由多專科之醫護人員所提供的許多介入措施。儘管最近強調醫療的照護品質,但很少有直接針對外傷醫師與管理者的研究,關於如何最佳監測並改善外傷系統中提供照護的品質。稽核關卡是一種用來改善照護品質的機制,它被定義為特定的臨床過程或照護結果,當它們出現時,代表有偏離規範的不利影響並提示進行檢視與回饋。雖然稽核關卡被廣泛地利用以改善外傷系統的成果,但尚未客觀地系統性回顧其效果。

目標

確定外傷統中採用稽核關卡用來改善照護過程與臨床結果的效果。

搜尋策略

我們的檢索策略包括以下資料庫的電子檢索,the Cochrane Injuries Group Specialized Register,the Cochrane EPOC Group Specialized Register,CENTRAL (考科藍圖書館,2008年,第4期),MEDLINE,PubMed,EMBASE,CINAHL,與ISI Web of Science:(SCIEXPANDED與CPCIS)。我們人工檢索the Journal of Trauma,Injury,Annals of Emergency Medicine,Academic Emergency Medicine,與Injury Prevention。我們檢索了兩個臨床試驗登記資料庫:1) The World Health Organization International Clinical Trials Registry Platform,以及2) Clinical Trials.gov。另外我們也連絡原文的專家以取得更多的文章。最近一次的電子檢索在2008年12月完成,而人工檢索在2009年2月完成。

選擇標準

我們搜尋使用稽核關卡作為改善嚴重受傷病患之照護過程,發病率或死亡率的介入措施的隨機對照試驗,對照臨床試驗,前後對照研究,與間斷時間序列研究。

資料收集與分析

兩名作者分別獨立檢視搜尋的結果,應用納入標準,並摘錄資料。

主要結論

沒有找到符合這篇回顧納入標準的研究。

作者結論

以稽核關卡作為改善外傷系統的介入措施,我們無法找到任何具有足夠方法學品質的研究來推論它的效益。相較於改善受傷患者的照護過程、功能恢復與死亡率的其他品質改善策略,嚴謹設計的進一步研究應重視稽核關卡的相對效益。

翻譯人

本摘要由高雄榮民總醫院金沁琳翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

稽核關卡用來改善外傷照護。在全世界,重大損傷是造成死亡和降低生活品質的重要原因。過去的研究顯示,當嚴重受傷的病患被管理在一個有組織的照護系統中,包括由護理人員照護,交通接駁到一個有專科醫師可以治療他們受傷的醫院,以及其他醫療人員幫助他們復健,則病患較有可能存活並減少失能的機會。有許多方法可以確定並改善外傷系統中提供給受傷病患的照護品質。外傷的稽核關卡可描述為應採取的具體行動、應提供測試或治療的時間架構、或者為預期發生在受傷病患的結果。對於偏離稽核關卡所描述的病患照護進行檢視,並且提供回饋給照護該病患的臨床醫師,此方法預期可以修正錯誤並改善未來表現。我們的研究嘗試去確定稽核關卡對於改善外傷照護多麼有效。我們無法找到任何可以納入回顧中的研究。需要更多的研究以確定稽核關卡對於改善照護是有效的,如果有效,那麼相較於其他的品質改善策略,稽核關卡有多有效。