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Guidelines for Trauma Quality Improvement Programmes . By the World Health Organization, International Association for Trauma Surgery and Intensive Care. Geneva, Switzerland : WHO Press , 2009 ; 104 pp; CHF/US $20.00, in developing countries CHF/US $14.00 (paperback) .

Trauma is the leading cause of death and disability worldwide. The implications of this are recognized globally, and there has been a universal push for the implementation of organized trauma systems to better address the acute care of the injured patient. A trauma system is a structured, highly coordinated program that is responsible for the development, execution, and continuous monitoring of trauma care services in a defined geographic area. The process of caring for an injured patient will involve multiple interactions and several different agencies. As patient outcomes are particularly time-sensitive, the success of a trauma system is dependent on a flawless transition between each phase of care.

Many regions have recognized the significance of a structured trauma system and are working to implement such programs. With the growth of such programs comes the need for guidelines to better monitor outcomes, detect preventable errors, and initiate corrective actions. The World Health Organization and the International Association for Trauma Surgery and Intensive Care have worked collaboratively to produce such guidelines in their newly published text, Guidelines for Trauma Quality Improvement Programmes. The guidelines provided are broadly constructed and are therefore applicable to all levels of care providers involved. The guidelines are also intended to be universally applicable to all countries, no matter what their economic level.

The text is divided into five chapters. The first two chapters give readers an introduction and overview of the field of quality improvement (QI). It provides the basic definitions of QI and the principles needed to ensure the success of a QI program. Potential corrective strategies are provided to emphasize the importance of “closing the loop” in the QI process. The third chapter discusses the benefits of QI programs. This includes a review of the published literature, as well as examples of how trauma QI programs have been implemented and used in low- and middle-income countries. The information provided is easy to read and accompanied by tables and figures that help to summarize the provided information.

The fourth chapter is the longest and most detailed. It reviews the most common and most successful methods for trauma QI in a step-by-step fashion. These include morbidity and mortality conferences; panel reviews of preventable deaths; and tracking of audit filters, complications, adverse events, errors, and sentinel events. There is also a discussion of statistical methods used to compare injuries between patients in an objective manner.

The book concludes with a discussion of how the recommended guidelines will both overlap with and work in conjunction with local programs and practices that are already in place in a particular region. They provide readers with access to several additional resources, including websites with recommendations for development of individual institutional protocols, as well as resources and training materials.

Perhaps the most interesting and clinically useful part of the text is the annex, which includes sample individual cases for review. Each case is categorized as a death or complication. The particular deficiencies in care are discussed. There is then a detailed, bulleted list of suggested corrective actions.

The guidelines provided are an excellent basis for initiating a trauma QI program. These guidelines can be applied in the prehospital or fixed care setting. However, this book needs to address how to integrate the prehospital QI with QI for fixed care facilities within a trauma system, state, or country. This book recognizes that adequate data collection is necessary for QI programs, but it also needs to address the need for standardized medical records for trauma within a system, so that information can be shared between QI programs at tertiary care centers and referral centers for better patient outcomes. Although this is a book that provides guidelines on setting up QI programs for trauma, there are a few areas that still need to be addressed.

Guidelines for Trauma Quality Improvement Programmes provides readers with a crash course in QI. It is a concise text that thoroughly describes the QI process. The guidelines provided are easy to understand and broad enough to be implemented into most trauma systems worldwide.