The Impact of a Pan-regional Inclusive Trauma System on Quality of Care

Objectives: To evaluate the impact of the implementation of an inclusive pan-regional trauma system on quality of care. Background: Inclusive trauma systems ensure access to quality injury care for a designated population. The 2007 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found quality deficits for 60% of severely injured patients. In 2010, London implemented an inclusive trauma system. This represented an opportunity to evaluate the impact of a pan regional trauma system on quality of care. Methods: Evaluation of the London Trauma System (ELoTS) utilized the NCEPOD study core methodology. Severely injured patients were identified prospectively over a 3-month period. Data were collected from prehospital care to 72h following admission or death. Quality, processes of care, and outcome were assessed by expert review using NCEPOD criteria. Results: Three hundred and twenty one severely injured patients were included of which 84% were taken directly to a major trauma center, in contrast to 16% in NCEPOD. Overall quality improved with the proportion of patients receiving good overall care increasing significantly [NCEPOD: 48% vs ALL-ELoTS: 69%, RR 1.3 (1.2 to 1.4), P < 0.01], primarily through improvements in organizational processes rather than clinical care. Improved quality was associated with increased early survival, with the greatest benefit for critically injured patients [NCEPOD: 31% vs All-ELoTS 11%, RR 0.37 (0.33 to 0.99), P = 0.04]. Conclusions: Inclusive trauma systems deliver quality and process improvements, primarily through organizational change. Most improvements were seen in major trauma centers; however, systems implementation did not automatically lead to a reduction in clinical deficits in care.