TRAUMA AUDIT AND QUALITY IMPROVEMENT

Audit is the evaluation of patient care. The care of the injured patient commences at the accident scene and involves prehospital triage and management, emergency hospital assessment and resuscitation, diagnostic and therapeutic interventions, operative surgery, intensive care unit management, acute hospital care and rehabilitation. Audit assesses the delivery of trauma care and clinical management and through identification of inadequacies facilitates the introduction of appropriate improvements. Both the American National Academy of Sciences—National Research Council and the Australian National Health & Medical Research Council have recommended the establishment of an audit process to evaluate the quality of trauma management and to obtain quality assurance. They have advised that this process would be assisted by the development of regional trauma registries and a uniform approach to the grading of injuries. Reduction in the preventable death rate, frequency of complications and duration of hospitalization has followed audits as a result of changes in the organization and quality of trauma care. In the United States, for example, the preventable death rate after injury was reduced from 35 to 15% in Orange County, California and from 14 to 3% in San Diego County, California. Studies from Great Britain, The Netherlands, Canada, Australia and elsewhere have further supported the view that trauma audit modifies practice leading to reductions in mortality and morbidity.