Trauma System Agenda for the Future
 

Index

What is Trauma

What is Trauma Systems

The Vision

Executive Summary

Introduction

Comprehensive Trauma Care System: Fundamental Components of Trauma Care

Comprehensive Trauma Care System: Key Infrastructure Elements

Conclusion

Glossary

References

Appendices

Information Management

Current Status

While information management should be a cornerstone of the trauma care system enabling research, care management, and performance improvement, often the existing databases and information management systems have serious shortcomings.

There are gaps in existing trauma data registries at the national level. The National Trauma Databank is based on samples of hospitals that choose to submit data. However, the size of these databases (NTDB included nearly 500,000 cases in 2002) may offset some concerns about their representativeness. This creates limitations both in terms of monitoring and evaluating the quality of care and determining the epidemiology of injury. The Pediatric Trauma Registry needs to be linked with the National Trauma Databank at the data element level. The database should be internet accessible and universally available.

Finally, there is a need for more evidence regarding the overall value of trauma care as well as for data regarding the contribution of individual components of a trauma system and what value each provides to the effectiveness of the system. Trauma system advocates need better data in order to garner support from legislators and local policy makers.

While trauma systems historically have set an example for performance improvement, there is a need to change the culture of quality improvement from punishment to system performance improvement. There is building public concern regarding patient safety and error reduction in all of health care. Patient records are essential to performance improvement (including patient safety information) and such records must be accessible for these purposes, while being protected from inappropriate disclosure.

The Vision

•  A national database and uniform data standards will be used to facilitate hospital operations and provide regional and national information regarding availability of post-hospital care. Existing resources should provide the foundation to be built upon. Applicable data sets should be revised as necessary and there should be increasing use of computerized medical records.

•  Trauma care will be designated as a specific research area for epidemiological study. Predictive models will be developed regarding outcomes and will be used in making funding and resource deployment decisions.

•  Pre-hospital and functional outcomes will be tracked and used in a Total Quality Management initiative to improve policies, procedures, and processes throughout the trauma continuum. Information will be used to develop performance standards and measure system performance against similar systems (benchmarking).

•  Information related to the complete cycle of trauma-from prevention to post-hospital care-will be collected, analyzed, and made available to facilitate improvements in injury prevention, response times, patient care, and rehabilitation.

•  Information systems should be usable for multi-center studies.

•  A standardized training course will be used to enable trauma registrars to collect and categorize data in a consistent, comparable manner.

•  Clear evidence will exist to document the contribution of an injury management system (prevention and treatment) to a community's overall health, and additional research will demonstrate which components of a trauma system provide the most value.

•  Tools will be developed and region-specific injury data will be available to assist communities in making decisions about their specific needs related to trauma system development, particularly regarding which components will best meet community health needs.

•  The culture of quality improvement will shift from using data to blame individuals to using the data to improve performance of the system.

•  Access to and appropriate protection of patient records and quality improvement data will be addressed through legislative and regulatory changes at state and federal levels.

•  Efforts to enhance patient confidentiality should be balanced with the need for strong research.