Safe Trauma Care. a national project for improved quality and safety in Swedish trauma care. Pelle Gustafson, MD, PhD

Transcription

1 Safe Trauma Care a national project for improved quality and safety in Swedish trauma care Pelle Gustafson, MD, PhD Chief Medical Officer The Swedish National Patient Insurance Company (Löf)

2 The Safe-projects 2007 Safe Delivery Care Decrease delivery injuries in children and mothers 2008 PRISS (ProtesRelaterade Infektioner Ska Stoppas) Decrease the incidence of PJI by 50 % 2010 Safe Abdominal Surgery Decrease the risk of injury after abdominal surgery by 50 % 2014 Safe Trauma Care Improve quality and safety in trauma care 2017 Safe Suicide Prevention Decrease the number of suicides after earlier attempts

3 Svensk Förening för Klinisk Farmakologi

4 Basic principles The professional organisations: - decide on medical aspects - appoint reviewers and expert groups - communicate the project to members Löf: - gives financial and administrative support Members of the steering committee and reviewers represent their organisations, not themselves The hospitals participate on a voluntary basis Secrecy within the projects

5 Basic principles Self-assessment, peer-review and follow-up Multiprofessional cooperation No supervision, but help to improve

6 Results from Safe Delivery Care Awareness on strengths and weaknesses Dissemination of knowledge and ideas Several hundred local improvement activities Definition of CTG parameters CTG-education NeoHLR-education Pelvic floor injuries-education Local routines Arena for professional exchange and cooperation

7 Results from Safe Delivery Care

8 Results from PRISS Awareness on strengths and weaknesses Dissemination of knowledge and ideas Over 800 local improvement projects completed Four expert group documents with best practice Instrument for local follow-up of adherence to routines Arena for professional exchange and cooperation

9 Results from PRISS

10 Results from PRISS

11 Safe Trauma Care Goal: Method: Decrease morbidity and mortality in trauma By self-assessment, external peer-review and follow-up contribute to improved quality and safety in Swedish trauma care

12 Swedish trauma problems Safe society Sparsely populated Ongoing restructuring of health-care system Limited real cooperation between hospitals Focus on individuals Lack of improvement systems

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14 Reviewed regions Värmland HT 14 VG-regionen HT 15 Stockholm-Mälardalen-Visby VT 16 Södra regionen VT 17 Sydöstra regionen HT 17 Mellersta regionen VT 18 Norra regionen VT 19

15 The review Self-assessment questions Site visit Agreement on action Feed-back and follow-up

16 The review process 6 months to 1 year Introduction visit Self assessment Local action Introduction for reviewers Local feed-back report Follow-up Site visit National follow-up and improvement work Regional feed-back report Follow-up Regional actions

17 The self-assessment questions Three different patient scenarios: Patient A prehospital, A/E, A/B/C-problems Patient B intrahospital, decision-making, C/D-problems Patient C system question, rehab, E-problem Overarching questions background information

18 5 recurring questions a) Which routines/guidelines do you have? b) How do you create conditions for adherence? c) How do you measure adherence? d) How do you feed-back the results (of c) to staff? e) Which ideas do you have on improvements (a - d)?

19 The site visit (2 days) Interviews Assessment of facilities Completion of self-assessment Trauma exercises Preliminary feed-back

20 Why are exercises part of the review?

21 Luck?.. I know nothing about luck, more than that the more I practice, the more luck I seem to have

22 Two parts of the exercises Execution Evaluation

23 The exercises - aim Follow the patient through the hospital Equipment, facilities, logistics Map vs. reality Local guidelines: adherence? adequacy? Right person, right place, right time? Roles and organisation How are the exercises evaluated? Non-technical skills? Lessons incorporated?

24 Three separate scenarios Exercise 1A + 1B Primary work-up Prehospital and A/E Exercise 2 Acute trauma laparotomy A/E or radiology and surgery Exercise 3 Acute secondary transport ICU and transport organisation

25 Feed-back reports Feed-back report Agreement on activities Follow-up and final report

26 Early impressions (not completely exclusive for trauma care ) Large commitment Parallel systems and processes Poor systems for improvement Poor follow-up Not always obvious why exercises are done Individual competence not the problem, but system competence is

27 Early impressions

28 National quality improvement work National trauma alert criteria Teamleader education Guidelines for Trauma CT Guidelines for prehospital immobilisation National center of competence

29 Questions?