Trauma Plan- System Quality Management Program
Continuous Quality Improvement
(CQI)
Revised April 2010
Introduction: What is CQI?
Continuous Quality Improvement (CQI) is, in its most basic sense, a way of approaching and examining any process within a system and seeking to create beneficial changes in that process in order to provide improved service (or product) within that system. The term "system" is extremely important in approaching any problem by CQI standards, as this approach seeks to view the issues under consideration more from a generalized standpoint, and is less interested (at the onset) in the individual inputs into the system (or in the case of Trauma care, less in the individual providers of the care, and more into the overall functioning of the system as a whole.) In even more basic terms, CQI seeks to examine the "forest" first, instead of starting with the individual "trees". An old axiom in CQI circles is that "any problem is (usually) 80% due to the system, and only 20% due to the individual inputs."
A well-developed CQI process, however, does not ignore individual inputs into the system, but should be organized to look at those individual inputs as a part of the greater whole. For example, as in the case of a trauma care system, an individual ambulance crew serves as an input to the system, bringing an injured patient from the field, and administering important initial care. While a CQI process would be most interested in the overall care of the trauma patient (outcome of care and efficiency of passage of the patient from the field, to a Level IV facility, and then on to definitive care, for example), the CQI process must also address the performance issues and the needs of this individual ambulance crew.
CQI begins with (1) Identification of the problem to be considered, then moves through the following steps: (2) elaborating the causes of the problem, (3) developing aids or remedies to the problem, (4) laying out a plan to correct the problem, (5) enforcing the plan of correction, and then (6) reexamining the problem. This final step is known also as "closing the loop," and is a key element in the process. This system-based approach to problem solving is ideally suited to TSA-C in its efforts to implement and improve care in the area that it serves.
Current Limitations of CQI in TSA-C
The primary and most daunting limitation to the CQI process for TSA-C is the process' dependence on the collection of the meaningful data for analysis of systems-based issues. Steps have been taken to institute a system for regional trauma data collection for both EMS and hospital providers (see below). Until this is accomplished in a manner that would allow for the tracking of cases through the entire system, the CQI committee's functions will be limited.
The CQI Committee:
This committee of NTRAC, composed of volunteers from the general membership of the association, and with a chair appointed by the Executive Committee, is charged with overseeing the CQI process within TSA-C. Its membership should be diverse, representing all aspects of the trauma care process, including first responders, EMS providers, nurses, physicians, educators, and hospital administration, as well as interested lay people.
Regular meetings shall be held by the committee as determined by the chair and as per the Bylaws of NTRAC, and an annual budget shall be submitted to the Finance Committee as per the Bylaws of TSA-C.
Functions of the Committee:
1. Supervision of the collection of data from the regional trauma database
2. Determining parameters for analysis of data from the database
3. Providing trauma-related data to the other committees of NTRAC
4. Providing data to the media and other interested entities regarding trauma and trauma care in the region
5. Providing objective statistical interpretation of trauma data as it relates to patient care and outcomes in the region
6. Ensuring the confidentiality of trauma data
7. Performing and modifying needs assessments within TSA-C for trauma system resources, including educational funding, system development funding, basic trauma equipment funding, and TSA-C administrative needs
8. Prioritizing the utilization of limited resources within the system
1. Data Collection:
NTRAC, TSA-C has approved the training and use of a Regional Data Base hosted by NTRAC and UR. The Regional Data Base has been available since the fall of 2007. The system is web based, available from any computer with Internet access, 24 hours per day, seven days per week.
The system will generate monthly or quarterly reports of the Minimum Data Set for TSA-C. Creating a method to track specific problems within our own region. Additionally, the system will provide additional reports, custom reporting criteria, or reports for a specific entity, upon request and negotiation of the cost of creating the report and coding the reporting form. In addition to the Minimum Data Set required for Texas Statewide Statistics, additional reporting fields will be investigated for use in TSA-C, specifically. Determination of which additional information may be useful will be carried out by the current CQI committee and submitted for approval. NTRAC has adopted a uniform Patient Care Forms that can be duplicated as an internet based, data entry form, allowing hospital and pre-hospital care givers to not only submit the data for Continuous Quality Improvement, but to also print the report for maintenance and record keeping ease.
2. Data Analysis:
Using statistical models, the data from the regional database can be utilized to determine several parameters of use in improving the quality and availability of care in the region. These parameters may include:
* Injury patterns and distribution - types and locations of trauma injury
* Morbidity and mortality - severity of injuries from trauma
* Availability of services - trauma care speed and access to care
* Quality of services - review of patient outcomes as related to care received
3. Data Sharing within TSA-C:
Several committees within NTRAC may need to utilize information gleaned from the regional trauma database. It shall be a primary concern of the CQI committee to serve as a conduit for this data, and as a source for data analysis for particular needs. Often, grant applications relating to preventive medicine and educational funding, for example, would require objective data to support the need for these projects being funded.
4. Data Sharing with the Regional Community:
Quite often, the media and other interested community groups, including law enforcement and public health entities, may need access to trauma-related data for their own public awareness programs and other needs that would complement the mission of NTRAC. The CQI Committee can provide these entities with accurate information, based on the actual care records.
5. Data Interpretation:
One of the most valuable functions that the CQI Committee can provide to NTRAC member entities, is the objective assessment and interpretation of trauma data as it relates to patient care. Utilizing a statistical approach to the database of information, the regional system can be viewed as a whole, and comparisons can be made within and between the parts of the system. It is important to note that this statistical data should not be utilized as a punitive tool to punish sub-par performers within the trauma system, but as a tool to identify areas in need of improvement, and further, the committee should present remedies for improving performance, with the object of improving the system in its entirety. These conclusions may also be passed on to other committees, for the purposes of initiating appropriate remedies within that particular committee's scope of authority.
6. Data Security:
The committee shall also be charged with devising mechanisms to ensure the maintenance of absolute confidentiality in patient information and in the information regarding individual providers within the system.
7. Needs Assessment:
With access to significant information from the trauma database, the CQI Committee is ideally suited to develop short and long-term needs assessments for the regional trauma system.
8. Resource Utilization Prioritization:
The CQI Committee shall, by virtue of its information access ability, be ideally suited to perform regional needs assessments in the areas of injury prevention, education, equipment, and personnel.
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