J Korean Med Sci.  2021 Jun;36(22):e149. 10.3346/jkms.2021.36.e149.

An Evaluation of the Effect of Performance Improvement and Patient Safety Program Implemented in a New Regional Trauma Center of Korea

• Huh Y
• Kwon J
• Moon J
• Kang BH
• Kim S
• Yoo J
• Song S
• Jung K

• KMID: 2516579
• DOI: http://doi.org/10.3346/jkms.2021.36.e149

Abstract

Background
This study examined the impact of the performance improvement and patient safety (PIPS) program implemented in 2015 on outcomes for trauma patients in a regional trauma center established by a government-led project for a national trauma system in Korea.
Methods
The PIPS program was based on guidelines by the World Health Organization and American College of Surgeons. The corrective strategies were proceeded according to the loop closure principle: data-gathering and monitoring, identification of preventable trauma deaths (PTDs), evaluation of preventable factors, analysis of findings, and corrective action plans. We established guidelines and protocols for trauma care, conducted targeted education and peer review presentations for problematic cases, and enhanced resources for improvement accordingly. A comparative analysis was performed on trauma outcomes over a four-year period (2015–2018) since implementing the PIPS program, including the number of trauma team activation and admissions, time factors related to resuscitation, ventilator duration, and the rate of PTDs.
Results
Human resources in the center significantly increased during the period; attending surgeons responsible for trauma resuscitation from 6 to 11 and trauma nurses from 85 to 218. Trauma admissions (from 2,166 to 2,786), trauma team activations (from 373 to 1,688), and severe cases (from 22.6 to 33.8%) significantly increased (all P < 0.001). Time to initial resuscitation and transfusion significantly decreased from 120 to 36 minutes (P < 0.001) and from 39 to 16 minutes (P < 0.001). Time to surgery for hemorrhage control and decompressive craniotomy improved from 99 to 54 minutes (P < 0.001) and 181 to 135 minutes (P = 0.042). Ventilator duration and rate of PTDs significantly decreased from 6 to 4 days (P = 0.001) and 22.2% to 8.4% (P = 0.008).
Conclusion
Implementation of the PIPS program resulted in improvements in outcomes at a regional trauma center that has just been opened in Korea. Further establishment of the PIPS program is required for optimal care of trauma patients.

Keyword

Wounds and Injuries; Trauma Centers; Quality Improvement; Patient Safety; Treatment Outcome; Mortality

Figure

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  Fig. 1 Flow chart outlining components of our PIPS program initiated in 2015 and study design according to principles of “closing the loop.”PIPS = performance improvement and patient safety, CNS = central nervous system, MODS = multiple organ dysfunction syndrome, ICU = intensive care unit, TTA = trauma team activation, RSI = rapid sequence intubation, MTP = massive transfusion protocol, EDT = emergency department thoracotomy, REBOA = resuscitative endovascular balloon occlusion of the aorta, VTE = venous thromboembolism, ATLS = Advanced Trauma Life Support, ATCN = Advanced Trauma Care for Nurses, TCAR = Trauma Care After Resuscitation, TPM = trauma program manager, TMD = trauma medical director, LOS = length of stay, OR = operation room, EDH = epidural hemorrhage, SDH = subdural hemorrhage.

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  Fig. 2 Progressive enhancement of human resources dedicated to trauma care. (A) Comparison of trauma specialists, (B) Comparison of trauma nurses, (C) Comparison of trauma nurse practitioners and coordinators.T-ICU = trauma-intensive care unit, T-OR = trauma-operation room, T-bay = trauma-bay.

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