Interdisciplinary trauma management and quality assessment at the Karl Franzens University Hospital, Graz

BACKGROUND: Between 1999 and 2001, 368 polytrauma patients were treated at the Departments of Traumatology and Surgery of the Karl Franzens University Hospital in Graz, Austria. In 1993, primary interdisciplinary polytrauma management was introduced in the emergency room. Subsequently, responsibilities were reevaluated regularly and cooperation was found to improve steadily. METHODS: All polytrauma patients were classified using the polytrauma registry of the German Society for Traumatology (Deutsche Gesellschaft für Unfallchirurgie, DGU) for evaluation and statistical analysis. Additionally, polytrauma cases have been analyzed at weekly interdisciplinary meetings since April 2000 to ensure an objectively high quality in polytrauma diagnosis and treatment. RESULTS: For trauma patients with an average Injury Severity Score (ISS) of 26.6, the average lengths of stay in the ICU (8.3 days) and in the hospital (21.8 days), were very short. In the year 2000, actual mortality was lower (18.8%) than that precalculated using Trauma Injury Severity Scale (TRISS). In 2001, this was the 4th best standardized mortality score of all participating trauma facilities. CONCLUSIONS: Primary interdisciplinary teamwork in the emergency room of trauma departments is recommended. Selecting the trauma leader depending on the nature of the patient's injuries is the most logical ongoing step towards a specialized medical system in which patients receive optimal treatment under the direction of the most appropriate specialist. In 83% of all polytrauma cases, the trauma leader was an orthopedic trauma surgeon. As this high standard of polytrauma care can only be guaranteed by a quality-management system, there has to be, in addition to the DGU evaluation, a retrospective weekly analysis of the treatment of polytrauma patients in which all of the involved specialists are invited to participate.