Management of the Complex Trauma Patient With Limited Resources

Trauma systems provide lifesaving care for complex trauma patients but at a significant cost. With both government and private funding sources becoming scarce, the business principles of process improvement and control have been applied to health care, simultaneously shifting the focus to quality and profit. Expenses are decreased by limiting costs for materials, limiting unnecessary training, and reducing both variability and complications. Training requirements for any particular task or patient care activity are reduced by establishing routine protocols to enable physician assistants and nurse practitioners to perform duties that at one time were performed only by physicians. Routine algorithms for items such as ICU and postoperative management all reduce variability and result in standardized care. This permits analysis and performance improvement within a hospital and across hospitals nationally. To this end, the American College of Surgeons National Surgical Quality Improvement Project is a risk-adjusted outcomes-based program created to provide tools and data to hospitals for quality improvement in surgical care. The analogy for trauma care is the Trauma Quality Improvement Program. Trauma Quality Improvement Program and other quality improvement strategies are increasingly being applied to trauma systems and programs to provide higher quality care, greater standardization, fewer complications for patients, and reduced costs.