Indicators of the quality of trauma care and the performance of trauma systems
Article first published online: 22 DEC 2011
Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
British Journal of Surgery
Supplement: Trauma Supplement
Volume 99, Issue S1, pages 97–104, January 2012
How to Cite
Gruen, R. L., Gabbe, B. J., Stelfox, H. T. and Cameron, P. A. (2012), Indicators of the quality of trauma care and the performance of trauma systems. Br J Surg, 99: 97–104. doi: 10.1002/bjs.7754
- Issue published online: 22 DEC 2011
- Article first published online: 22 DEC 2011
- Manuscript Accepted: 9 SEP 2011
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.
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.
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.
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.