Trauma system performance improvement: a review of the literature and recommendations

Evaluation of trauma systems has matured over the last few decades. US trauma systems routinely undergo clinical and operational evaluation to ensure optimal care of the injured from the time of injury through reintegration with society. Assessments are carried out with the intent of defining optimal elements and rendering strategic recommendations for the trauma system. The framework for trauma system assessment was adopted from the Trauma Care Systems Planning and Development Act of 1990 which sought to create a consistent process and core functions to ensure a reproducible trauma system from prehospital through rehabilitation. Applying the core function of a public health model to trauma systems provided a process for enhancement of clinical care along the continuum through a framework that accentuates assessment, policy development and assurance while holding to the highest standards in trauma systems performance. A review of contemporary and evidence-based information regarding key strategies and processes related to the evaluation of trauma systems’ performance improvement was undertaken. The intent was to identify measurable metrics for trauma systems performance improvement and patient safety. There is a paucity of data related to specific metrics to evaluate the impact of trauma systems on performance and outcomes. The majority of publications focused on quality of trauma registry data, integration of prehospital data, and the core functions of a trauma system but lacked specific quantitative metrics to measure these core functions. The qualitative responses of “met or not met” can be subjective and equivocal. The American College of Surgeons Committee on Trauma (ACS COT) Trauma System Evaluation Committee has also developed qualitative minimal trauma system standards and implemented a comprehensive trauma system evaluation process. Trauma system-wide, risk adjusted, qualitative and quantitative metrics are recommended to address the full spectrum of injury which are essential to the advancement of the care of the injured patient.