A checklist for trauma quality improvement meetings

A process improvement study

G. M. O'Reilly, J. Mathew, N. Roy, A. Gupta, M. Joshipura, N. Sharma, B. Mitra, P. A. Cameron, M. Fahey, T. Howard, V. Kumar, B. Jarwani, K. D. Soni, A. Thakor, S. Dharap, P. Patel, A. Jhakal, N. C. Farrow, M. C. Misra, R. L. Gruen & 1 others M. C. Fitzgerald

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Each year approximately five million people die from injuries. In countries where systems of trauma care have been introduced, death and disability have decreased. A major component of developed trauma systems is a trauma quality improvement (TQI)program and trauma quality improvement meeting (TQIM). Effective TQIMs improve trauma care by identifying and fixing problems. But globally, TQIMs are absent or unstructured in most hospitals providing trauma care. The aim of this study was to implement and evaluate a checklist for a structured TQIM. Methods: This project was conducted as a prospective before-and-after study in four major trauma centres in India. The intervention was the introduction of a structured TQIM using a checklist, introduced with a workshop. This workshop was based on the World Health Organization (WHO)TQI Programs short course and resources, plus the developed TQIM checklist. Pre- and post-intervention data collection occurred at all meetings in which cases of trauma death were discussed. The primary outcome was TQIM Checklist compliance, defined by the discussion of, and agreement upon each of the following: preventability of death, identification of opportunities to improve care and corrective actions and a plan for closing the loop. Results: There were 34 meetings in each phase, with 99 cases brought to the pre-intervention phase and 125 cases brought to the post-intervention phase. There was an increase in the proportion of cases brought to the meeting for which preventability of death was discussed (from 94% to 100%, p = 0.007)and agreed (from 7 to 19%, OR 3.7; 95% CI:1.4–9.4, p = 0.004)and for which a plan for closing the loop was discussed (from 2% to 18%, OR 10.9; 95% CI:2.5–47.6, p < 0.001)and agreed (from 2% to 18%, OR 10.9; 95% CI:2.5–47.6, p < 0.001). Conclusion: This study developed, implemented and evaluated a TQIM Checklist for improving TQIM processes. The introduction of a TQIM Checklist, with training, into four Indian trauma centres, led to more structured TQIMs, including increased discussion and agreement on preventability of death and plans for loop closure. A TQIM Checklist should be considered for all centres managing trauma patients.

Original languageEnglish
Number of pages6
JournalInjury
DOIs
Publication statusAccepted/In press - 8 Apr 2019

Keywords

  • India
  • Quality
  • Wound and injuries

Cite this

O'Reilly, G. M. ; Mathew, J. ; Roy, N. ; Gupta, A. ; Joshipura, M. ; Sharma, N. ; Mitra, B. ; Cameron, P. A. ; Fahey, M. ; Howard, T. ; Kumar, V. ; Jarwani, B. ; Soni, K. D. ; Thakor, A. ; Dharap, S. ; Patel, P. ; Jhakal, A. ; Farrow, N. C. ; Misra, M. C. ; Gruen, R. L. ; Fitzgerald, M. C. / A checklist for trauma quality improvement meetings : A process improvement study. In: Injury. 2019.
@article{8dd5c90acd7949a5b716af851f9b4840,
title = "A checklist for trauma quality improvement meetings: A process improvement study",
abstract = "Background: Each year approximately five million people die from injuries. In countries where systems of trauma care have been introduced, death and disability have decreased. A major component of developed trauma systems is a trauma quality improvement (TQI)program and trauma quality improvement meeting (TQIM). Effective TQIMs improve trauma care by identifying and fixing problems. But globally, TQIMs are absent or unstructured in most hospitals providing trauma care. The aim of this study was to implement and evaluate a checklist for a structured TQIM. Methods: This project was conducted as a prospective before-and-after study in four major trauma centres in India. The intervention was the introduction of a structured TQIM using a checklist, introduced with a workshop. This workshop was based on the World Health Organization (WHO)TQI Programs short course and resources, plus the developed TQIM checklist. Pre- and post-intervention data collection occurred at all meetings in which cases of trauma death were discussed. The primary outcome was TQIM Checklist compliance, defined by the discussion of, and agreement upon each of the following: preventability of death, identification of opportunities to improve care and corrective actions and a plan for closing the loop. Results: There were 34 meetings in each phase, with 99 cases brought to the pre-intervention phase and 125 cases brought to the post-intervention phase. There was an increase in the proportion of cases brought to the meeting for which preventability of death was discussed (from 94{\%} to 100{\%}, p = 0.007)and agreed (from 7 to 19{\%}, OR 3.7; 95{\%} CI:1.4–9.4, p = 0.004)and for which a plan for closing the loop was discussed (from 2{\%} to 18{\%}, OR 10.9; 95{\%} CI:2.5–47.6, p < 0.001)and agreed (from 2{\%} to 18{\%}, OR 10.9; 95{\%} CI:2.5–47.6, p < 0.001). Conclusion: This study developed, implemented and evaluated a TQIM Checklist for improving TQIM processes. The introduction of a TQIM Checklist, with training, into four Indian trauma centres, led to more structured TQIMs, including increased discussion and agreement on preventability of death and plans for loop closure. A TQIM Checklist should be considered for all centres managing trauma patients.",
keywords = "India, Quality, Wound and injuries",
author = "O'Reilly, {G. M.} and J. Mathew and N. Roy and A. Gupta and M. Joshipura and N. Sharma and B. Mitra and Cameron, {P. A.} and M. Fahey and T. Howard and V. Kumar and B. Jarwani and Soni, {K. D.} and A. Thakor and S. Dharap and P. Patel and A. Jhakal and Farrow, {N. C.} and Misra, {M. C.} and Gruen, {R. L.} and Fitzgerald, {M. C.}",
year = "2019",
month = "4",
day = "8",
doi = "10.1016/j.injury.2019.04.003",
language = "English",
journal = "Injury",
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publisher = "Elsevier",

}

A checklist for trauma quality improvement meetings : A process improvement study. / O'Reilly, G. M.; Mathew, J.; Roy, N.; Gupta, A.; Joshipura, M.; Sharma, N.; Mitra, B.; Cameron, P. A.; Fahey, M.; Howard, T.; Kumar, V.; Jarwani, B.; Soni, K. D.; Thakor, A.; Dharap, S.; Patel, P.; Jhakal, A.; Farrow, N. C.; Misra, M. C.; Gruen, R. L.; Fitzgerald, M. C.

In: Injury, 08.04.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - A checklist for trauma quality improvement meetings

T2 - A process improvement study

AU - O'Reilly, G. M.

AU - Mathew, J.

AU - Roy, N.

AU - Gupta, A.

AU - Joshipura, M.

AU - Sharma, N.

AU - Mitra, B.

AU - Cameron, P. A.

AU - Fahey, M.

AU - Howard, T.

AU - Kumar, V.

AU - Jarwani, B.

AU - Soni, K. D.

AU - Thakor, A.

AU - Dharap, S.

AU - Patel, P.

AU - Jhakal, A.

AU - Farrow, N. C.

AU - Misra, M. C.

AU - Gruen, R. L.

AU - Fitzgerald, M. C.

PY - 2019/4/8

Y1 - 2019/4/8

N2 - Background: Each year approximately five million people die from injuries. In countries where systems of trauma care have been introduced, death and disability have decreased. A major component of developed trauma systems is a trauma quality improvement (TQI)program and trauma quality improvement meeting (TQIM). Effective TQIMs improve trauma care by identifying and fixing problems. But globally, TQIMs are absent or unstructured in most hospitals providing trauma care. The aim of this study was to implement and evaluate a checklist for a structured TQIM. Methods: This project was conducted as a prospective before-and-after study in four major trauma centres in India. The intervention was the introduction of a structured TQIM using a checklist, introduced with a workshop. This workshop was based on the World Health Organization (WHO)TQI Programs short course and resources, plus the developed TQIM checklist. Pre- and post-intervention data collection occurred at all meetings in which cases of trauma death were discussed. The primary outcome was TQIM Checklist compliance, defined by the discussion of, and agreement upon each of the following: preventability of death, identification of opportunities to improve care and corrective actions and a plan for closing the loop. Results: There were 34 meetings in each phase, with 99 cases brought to the pre-intervention phase and 125 cases brought to the post-intervention phase. There was an increase in the proportion of cases brought to the meeting for which preventability of death was discussed (from 94% to 100%, p = 0.007)and agreed (from 7 to 19%, OR 3.7; 95% CI:1.4–9.4, p = 0.004)and for which a plan for closing the loop was discussed (from 2% to 18%, OR 10.9; 95% CI:2.5–47.6, p < 0.001)and agreed (from 2% to 18%, OR 10.9; 95% CI:2.5–47.6, p < 0.001). Conclusion: This study developed, implemented and evaluated a TQIM Checklist for improving TQIM processes. The introduction of a TQIM Checklist, with training, into four Indian trauma centres, led to more structured TQIMs, including increased discussion and agreement on preventability of death and plans for loop closure. A TQIM Checklist should be considered for all centres managing trauma patients.

AB - Background: Each year approximately five million people die from injuries. In countries where systems of trauma care have been introduced, death and disability have decreased. A major component of developed trauma systems is a trauma quality improvement (TQI)program and trauma quality improvement meeting (TQIM). Effective TQIMs improve trauma care by identifying and fixing problems. But globally, TQIMs are absent or unstructured in most hospitals providing trauma care. The aim of this study was to implement and evaluate a checklist for a structured TQIM. Methods: This project was conducted as a prospective before-and-after study in four major trauma centres in India. The intervention was the introduction of a structured TQIM using a checklist, introduced with a workshop. This workshop was based on the World Health Organization (WHO)TQI Programs short course and resources, plus the developed TQIM checklist. Pre- and post-intervention data collection occurred at all meetings in which cases of trauma death were discussed. The primary outcome was TQIM Checklist compliance, defined by the discussion of, and agreement upon each of the following: preventability of death, identification of opportunities to improve care and corrective actions and a plan for closing the loop. Results: There were 34 meetings in each phase, with 99 cases brought to the pre-intervention phase and 125 cases brought to the post-intervention phase. There was an increase in the proportion of cases brought to the meeting for which preventability of death was discussed (from 94% to 100%, p = 0.007)and agreed (from 7 to 19%, OR 3.7; 95% CI:1.4–9.4, p = 0.004)and for which a plan for closing the loop was discussed (from 2% to 18%, OR 10.9; 95% CI:2.5–47.6, p < 0.001)and agreed (from 2% to 18%, OR 10.9; 95% CI:2.5–47.6, p < 0.001). Conclusion: This study developed, implemented and evaluated a TQIM Checklist for improving TQIM processes. The introduction of a TQIM Checklist, with training, into four Indian trauma centres, led to more structured TQIMs, including increased discussion and agreement on preventability of death and plans for loop closure. A TQIM Checklist should be considered for all centres managing trauma patients.

KW - India

KW - Quality

KW - Wound and injuries

UR - http://www.scopus.com/inward/record.url?scp=85064738983&partnerID=8YFLogxK

U2 - 10.1016/j.injury.2019.04.003

DO - 10.1016/j.injury.2019.04.003

M3 - Article

JO - Injury

JF - Injury

SN - 0020-1383

ER -