Chapter 16 of the Resources for Optimal Care of the Injured Patient Manual describes the concept of monitoring, evaluating, and improving the performance of a trauma program. Although there is no precise prescription for trauma performance improvement and patient safety (PIPS), the American College of Surgeons Committee on Trauma (ACS-COT) requires a structured effort by a trauma program to demonstrate a continuous process for improving care for injured patients.

Current health care imperatives emphasize doing more with less and doing it better and faster. Although this may be difficult to translate to the care of some trauma patients, an evidence-based rather than an empiric approach presents more meaningful criteria against which our trauma care can be measured. A standardized approach to recurring care issues minimizes unnecessary variation, allows better outcome assessment, and makes changes in care easier to implement and more uniform. Coordination of the trauma PIPS program into the hospital-wide program offers a reduction in labor while producing more impact on quality.

Patient safety is inseparable from the PIPS process and underscores an important program goal (Table 1). Safety in medical practice once was considered a “given,” but it is now recognized as something that clearly requires effort to achieve. The patient safety process directs its efforts at the environment in which care is given, and the PIPS process is directed at the care itself. The boundary between the performance improvement and patient safety processes often overlaps or is indistinct. A combined PIPS program is necessary to ensure optimal outcome.

The decrease of operative deaths associated with general anesthesia from 50 to 1 to 2 per million is cited as an example of how groups of physicians have successfully collaborated to improve a care process not only for their individual patients, but also for all patients undergoing anesthesia. The PIPS method, which involves guideline development, process assessment, process correction, and monitoring for improvement, may seem unnecessary to surgeons who are motivated and work hard at providing good patient care. However, health care experts believe that individual physicians simply trying harder will not result in better quality and safer patient care. The care process is complex, so responsibility for a patient’s safety and optimal outcome should be shared by all involved. In trauma centers with residency programs, residents should be exposed to the trauma PIPS process. This exposure is valuable training and might be used to demonstrate compliance with Accreditation Council for Graduate Medical Education core competency requirements.

Operational Concepts

Definitions

Supplemental Readings

Internet Resources

Trauma PIPS Toolbox

Oct 12 2:07pm

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