Boris Sobolev

BACKGROUND. Across Canada there are substantial differences in the organization and evaluation of regional trauma systems. The design, evaluation and improvement of trauma care is frustrated by variable definitions of trauma systems, their primary objectives, and preferred performance measures. Tools that support decision makers in design and policy development are needed 2, 3. OBJECTIVE. This research aimed to 1) describe decision makers’ perceptions of the scope and objectives of ideally organized regional systems of trauma care and injury control in Canada, and 2) identify decision makers’ informational needs, specifically with regard to performance measures meaningful as actionable guidance for the design and policy development of regional systems of trauma care and injury control. METHODS. Based on a literature review of commonly used trauma system performance measures, a 35-question structured electronic survey was constructed, vetted by a reference group of experts, tested, and circulated over a 3-week period. The framing sample was 342 health administrators and trauma directors self-reported to be involved in decision making for organized injury management and control from all health regions of Canada. Survey responses were collated and descriptive statistics generated. RESULTS. There were 82 complete responses for a response rate of 24.0%. There was strong support for a broadly inclusive definition of a trauma system and for government oversight using standard performance indicators. Among responders there was near equal support, 41.2% and 31.7% respectively, for ensuring delivery of rapid and appropriate care (processes of care) and minimizing individual and societal burden of injury (outcomes of care) as the overarching drivers of system design. Of 24 listed performance indicators, measures of timeliness of care, preventable deaths, severity-adjusted hospital mortality, safety, satisfaction and access to care were preferred. CONCLUSION. This study showed that decision makers responsible for regional trauma systems in Canada believe that the ideal trauma system should coordinate multiple agencies influential in injury management around clear system objectives that address both major and minor trauma, and that government endorsed national standards are needed to ensure efficient and effective processes that reduce the individual and societal burden of injury.

View record