The use of the STAF model was associated with a reduction in preventable trauma mortality. We recommend that the STAF model be implemented and tested in other locales.
The results indicate that education played a role in improving care, especially at the hospital level. All personnel involved in the care of trauma patients should have access to educational sessions aimed at providing up-to-date information for all levels of providers. Efforts need to be directed at involving physicians in this educational process. We recommend that further work be conducted on the role of education in trauma care.
Feedback is a necessary part of any improvement system. Ideally, there should be dedicated personnel at every hospital to collect, enter and track feedback data. However, the resources needed to fund such a feedback data program are immense. The development of electronic patient records may help, but this technology is still being developed. We envision a time in the future when statewide electronic prehospital and emergency department data systems include the identity of the medical providers treating the patient, the treatments received by each patient and edit checks to ensure complete and accurate data collection. With these electronic systems, routine reports could be generated as needed to indicate compliance with guidelines for different categories of patients, or for specific patients. These reports could summarize “compliance” by specific providers or by teams of providers in order to provide feedback to them when their treatment patterns are inconsistent with guidelines. We recommend that funding be directed toward the development of innovative, consistent, and inexpensive methods for delivering feedback to all providers, both prehospital and hospital, in a trauma care system. We further recommend that development plans for statewide electronic prehospital and emergency department data systems be encouraged and supported.
Implementation of regular multidisciplinary review panels could further contribute to the education of physicians, nurses, and prehospital personnel and the improvement of trauma care. All trauma deaths and severe injuries without death should be reviewed concurrently to ensure that current practice is being followed. These panel findings would also be useful to direct efforts aimed at improving outcomes for trauma patients. We recommend that all trauma care systems establish peer review panels as part of their quality improvement processes.
The results of this project imply many opportunities and needs for research. The first is to simply replicate the project to see if the STAF model has an effect in a different setting. In addition, work is needed to determine how best to implement different components of staff.
We recommend that funding be directed to stimulate further research of the STAF model.
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