René Grobler Mariesa Human

Netcare Milpark Hospital

Trauma Centre Accreditation as a Tool for

Focused Performance Improvement

Introduction Netcare Milpark Hospital was accredited as the first private Level I Trauma Centre in SA by the Trauma Society of South Africa (TSSA)

in March 2011 and re-verified as a Level I Trauma Centre in February 2014.

Problem: •  We continuously aim to improve the outcome of our trauma (injured)

patients. •  Compliance to specific international benchmark standards for time

management is essential in ensuring improved patient outcomes. •  Monitoring and peer review processes were started as part of the

weekly Trauma Outcome Review (TOR) meetings and monthly Trauma Morbidity & Mortality and Trauma Programme meetings.

Aim of Performance Improvement Focus

According to Guidelines of Trauma Centres – TSSA & Resources for Optimal Care of the Injured Patient

(American College of Surgeons):

•  Response Times of Trauma Surgeons: (≤ 10 minutes) •  Resuscitation Times – start of resuscitation efforts to the end of the

primary survey: (≤ 30 minutes) •  Total Resuscitation Times – start of resuscitation efforts to the time

the patient leave the Emergency Department: (≤60 minutes).

Strategy for Change

•  The relevant times were documented on the P1 Resuscitation document,

•  But no platform for evaluation and review as part of a continuous performance improvement focus.

Improvement of

Resuscitation Times

Arrival of Injured Patient

Documentation of Times on P1

Medibank Document

Review of Times during

TOR meetings

Peer Review during M&M and Trauma Managenent

Meetings

Improvment of Resuscitation

Times

Improved Patient

Outcomes

P-­‐D-­‐S-­‐A  CY

CLE

Implementation and Evaluation

Arrival of Injured Patient

Trauma Team Activation

Response Times of Trauma Surgeons (≤ 10 minutes)

Resuscitation Times (≤ 30 minutes)

Total Resuscitaion Times ( ≤ 60 minutes )

Improved Resuscitation Times

Improved Patient Outcomes

Evalua

/ons  during  TO

R;  M

&M  M

ee/n

gs

Introd

uc/o

n  of  clocks  F

eb  2014

Results: Average Response Times

12

10

6

0

2

4

6

8

10

12

14

2012 2013 2014

Tim

e in

Min

utes

Response Times Goal: ≤ 10 Minutes

Average Response Times for Trauma Surgeons

Goal:  10  Minutes

Results: Resus Times

00:32

00:25 00:24

00:00

00:07

00:14

00:21

00:28

00:36

2012 2013 2014

Tim

e in

Min

utes

Resus Times Goals: ≤ 30 Minutes

Average Resus Times

01:13 01:14

01:06

01:01 01:03 01:04 01:06 01:07 01:09 01:10 01:12 01:13 01:14

2012 2013 2014

Tim

e in

Min

utes

Total Resus Times: ≤ 60 Minutes

Average Total Resus Times

Goal:  30  Minutes

Goal:  60  Minutes

Lessons Learnt & Message to others

Lessons Learnt: Reduction of resuscitation times at Netcare Milpark Level I Trauma Centre through the implementation of the following

–  Measurement of Accurate Times: –  Activation of countdown clocks upon arrival of the injured patient –  Result: accurate documentation and constant focus on the “running” time. –  Review Process: –  Measurement, evaluation and review of process in order to identify and correct

causes for delay in not achieving goals (times)

Message to others: •  Effective monitoring of times in the management of an injured patient has a significant

influence and can improve the outcomes. •  Structured PI process (Documentation – TOR – M&M and Trauma Management Review

Meetings) contribute to achieving the improvement of the time standards and thus ultimately improve patient outcomes.