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Principales indicadores para medir el desempeño de la atención de emergencias traumatológicas / Indicators to measure the performance of emergency trauma care

Juan Daniel Vera-López, Ileana Beatriz Heredia-Pi, Ricardo Pérez-Núñez, Martha Hijar

Resumen


Resumen

El objetivo del presente trabajo fue identificar los principales indicadores utilizados para medir el desempeño en la atención de emergencias traumatológicas. Se realizó una revisión de la literatura de tipo narrativa en las bases de datos: PubMed, LILACS y Epistemónikos, se incluyeron publicaciones entre enero de 2011 y el 31 diciembre 2021, en español, inglés y portugués. Se identificaron 962 publicaciones. Tras revisar el texto completo, 48 artículos fueron incluidos. Los indicadores se clasificaron en las dimensiones de proceso y resultado. Se identificaron 100 diferentes indicadores para analizar el desempeño de la atención de emergencias traumatológicas. 71% fueron indicadores de proceso, entre ellos el tiempo de atención y el triaje. En la dimensión de resultados se identificaron 29 indicadores; la mortalidad fue el indicador mayormente analizado así como el periodo de estancia hospitalaria. Se identificaron seis indicadores sobre la discapacidad de las personas lesionadas y 14 indicadores relacionados con la satisfacción, el más frecuente fue quejas. Diversos indicadores han sido utilizados para evaluar el desempeño de la atención de emergencias traumatológicas. En la dimensión de resultados, los indicadores relacionados con la satisfacción y discapacidad han sido poco explorados. Los responsables de la atención de emergencias traumatológicas deben impulsar ejercicios de evaluación del desempeño para conocer su situación actual a través de indicadores sensibles y acordes con los datos disponibles.

 

Abstract

The objective of this paper was to identify the main indicators used to measure the performance in emergency trauma care. A literature review was carried out in the electronic databases: PubMEd, LILACS and Epistemónikos, including publications between January 2011 and December 31, 2021, in Spanish, English and Portuguese. Atotal of 962 publications were identified. When reviewing the full text, 48 articles were included. The indicators were classified in the dimensions of process and results. 100 different indicators were identified to analyze the performance of emergency trauma care. 71% were process indicators, including service time and triage. In the results dimension 29 indicators were identified; mortality was the indicator most analyzed as well as length of stay. Six indicators on the disability of injured people and 14 indicators related to satisfaction were identified, the most frequent being complaints. Various indicators have been used to assess the performance of emergency trauma care. In the results dimension, the indicators related to satisfaction and disability after injuries have been little explored. Decision-makers and those responsible for emergency care must promote performance evaluation exercises to learn about their current situation using appropriate and sensitive indicators with the available data.


Palabras clave


Evaluación de Resultados en la Atención de Salud; Servicios Médicos de Urgencia; Heridas y Lesiones / Outcome Assessment, Health Care; Emergency Medical Services; Wounds and Injuries

Texto completo:

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Referencias


Organización Mundial de la Salud. Evaluación del desempeño de los sistemas de salud. Organización Mundial de la Salud [Internet]. 2000 [citado 2023]. Disponible en: https://apps.who. int/gb/archive/pdf_files/EB107/se9.pdf.

Papanicolas I, Rajan D, Karanikolos M, et al (Eds.). (2022). Health system performance assessment: a framework for policy analysis. World Health Organization. Disponible en: https://apps.who.int/iris/handle/10665/352686.

Híjar Medina MC. Los accidentes como problema de salud pública en México. Retos y oportunidades [Internet]. México: Consejo Nacional de Ciencia y Tecnología, Academia Nacional de Medicina; 2014. [citado 2023]. 266 p. Disponible en: https://www.anmm.org.mx/publicaciones/CAnivANM150/L9- Los-accidentes-como-problema-salud-publica.pdf.

Global Burden of Disease Collaborative Network. Global Burden of Disease study 2019 (GBD 2019) results. Seattle: Institute for Health Metrics and Evaluation (IHME); 2020 [consultado 2022 Ene 30]. Disponible en: https://vizhub.healthdata.org/ gbd-results?params=gbd-api-2019-permalink/a3ea9a8fffb7b3ea28c1a9d4d119e7aa.

Reynolds TA, Sawe H, Rubiano AM, et al. Chapter 13: Strengthening Health Systems to Provide Emergency Care Strengthening Health Systems to Provide Emergency Care [Intenet]. In: Disease Control Priorities: Improving Health and Reducing Poverty. Jamison DT, Gelband H, Horton S, et al, ed. 3rd ed. Washington: The International Bank for Reconstruction and Development / The World Bank; 2017 [cited 2023]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525279/

World Health Organization. WHO Emergency care system framework [Internet]. Ginebra: World Health Organization; 2018 [consultado 2023]. Disponible en: https://www.who.int/ publications/i/item/who-emergency-care-system-framework.

72.a Asamblea Mundial de la Salud. Sistemas de atención de urgencia para la cobertura sanitaria universal: asegurar una atención rápida a los enfermos agudos y las personas con traumatismos [Internet]. Ginebra: Organización Mundial de la Salud; 2019 [consultado 2023]. Disponible en: https:// apps.who.int/iris/bitstream/handle/10665/329364/A72_R16- sp.pdf?sequence=1&isAllowed=y.

Organización Panamericana de la Salud. Fortalecer la atención de emergencias traumatológicas en la Región de las Américas [Internet]. Washington: OPS; 2023 [citado 2023 jul 12]. 61p. doi: 10.37774/9789275327166.

Jung K, Matsumoto S, Smith A, et al. Comparison of outcomes in severely injured patients between a South Korean trauma center and matched patients treated in the United States. Surgery. 2018;164(3):482–8. doi: 10.1016/j.surg.2018.04.031.

Snyder H. Literature review as a research methodology: An overview and guidelines. J Bus Res. 2019;104:333–9. doi: 10.1016/j.jbusres.2019.07.039.

Banco Mundial. Clasificación de Ingresos altos [Internet]. Grupo Banco Mundial. 2023 [consultado 2023]. Disponible en: https://datos.bancomundial.org/nivel-de-ingresos/ingreso-alto.

Donabedian A. The quality of care. How can it be assessed? JAMA. 1988; 30;260(12):1743-8. doi: 10.1001/jama.260.12. 1743.

Raj LK, Creaton A, Phillips G. Improving emergency department trauma care in Fiji: implementing and assessing the trauma call system. Emerg Med Australas. 2019;31(4):654–8. doi: 10.1111/1742-6723.13225.

Vera-López JD, Pérez-Núñez R, Gómez-García L, et al. La respuesta del Sistema Médico de Emergencias y su relación con distintos resultados en salud en personas lesionadas por el tránsito de dos ciudades mexicanas. Cad Saude Publica. 2018;34(10):1-15. doi: 10.1590/0102-311X00144916.

Henry JA, Reingold AL. Prehospital trauma systems reduce mortality in developing countries: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2012;73(1):261-8. doi: 10.1097/TA.0b013e31824bde1e.

Jansen JO, Morrison JJ, Wang H, et al. Access to specialist care: Optimizing the geographic configuration of trauma systems. J Trauma Acute Care Surg. 2015;79(5):756-65. doi: 10.1097/TA.0000000000000827.

Mehmood A, Rowther AA, Kobusingye O, et al. Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach. Int J Emerg Med. 2018; 11(1):53. doi: 10.1186/s12245-018-0207-6.

Mommsen P, Bradt N, Zeckey C, et al. Comparison of helicopter and ground emergency medical service: a retrospective analysis of a German rescue helicopter base. Technol Health Care. 2012;20(1):49-56. doi: 10.3233/THC-2011-0655.

Vainionpää T, Peräjoki K, Hiltunen T, et al. Integrated model for providing tactical emergency medicine support (TEMS): analysis of 120 tactical situations. Acta Anaesthesiol Scand. 2012; 56(2):158-63. doi: 10.1111/j.1399-6576.2011.02565.x.

Wilson SL, Gangathimmaiah V. Does prehospital management by doctors affect outcome in major trauma? A systematic review. J Trauma Acute Care Surg. 2017;83(5):965-74. doi: 10.1097/TA.0000000000001559.

Almasi S, Rabiei R, Moghaddasi H, et al. Emergency Department Quality Dashboard; a Systematic Review of Performance Indicators, Functionalities, and Challenges. Arch Acad Emerg Med. 202;9(1):1-11. doi: 10.22037/aaem.v9i1.1230.

Boschini LP, Lu-Myers Y, Msiska N, et al. Effect of direct and indirect transfer status on trauma mortality in sub Saharan Africa. Injury. 2016;47(5):1118-22. doi: 10.1016/j.injury.2016.01.015.

Cameron M, McDermott KM, Campbell L. The performance of trauma team activation criteria at an Australian regional hospital. Injury. 2019;50(1):39-45. doi: 10.1016/j.injury.2018.09.050.

Caputo LM, Salottolo KM, Slone DS, et al. The relationship between patient volume and mortality in American trauma centres: a systematic review of the evidence. Injury. 2014 Mar;45(3):478-86. doi: 10.1016/j.injury.2013.09.038.

Cole EM, West A, Davenport R, et al. Can residents be effective trauma team leaders in a major trauma centre? Injury. 2013;44(1):18-22. doi: 10.1016/j.injury.2011.09.020.

Wesson HK, Bachani AM, Wekesa JM, et al. Assessing trauma care at the district and provincial hospital levels: a case study of hospitals in Kenya. Injury. 2013;44 (Suppl. 4):S75-80. doi: 10.1016/S0020-1383(13)70217-1.

Havermans RJM, de Jongh MAC, Bemelman M, et al. Trauma care before and after optimisation in a level I trauma Centre: Life-saving changes. Injury. 2019;50(10):1678-83. doi: 10.1016/j.injury.2019.07.017.

Kuimi BLB, Moore L, Cissé B, et al. Influence of access to an integrated trauma system on in-hospital mortality and length of stay. Injury. 2015;46(7):1257-61. doi: 10.1016/j.injury. 2015.02.024.

Lansink KW, Gunning AC, Spijkers AT, et al. Evaluation of trauma care in a mature level I trauma center in the Netherlands: outcomes in a Dutch mature level I trauma center. World J Surg. 2013;37(10):2353-9. doi: 10.1007/s00268-013-2103-9.

Madsen M, Kiuru S, Castrèn M, et al. The level of evidence for emergency department performance indicators: systematic review. Eur J Emerg Med. 2015;22(5):298-305. doi: 10.1097/ MEJ.0000000000000279.

Matsushima K, Schaefer EW, Won EJ, et al. Injured adolescents, not just large children: difference in care and outcome between adult and pediatric trauma centers. Am Surg. 2013; 79(3):267–73.

Moore L, Lavoie A, Bourgeois G, et al. Donabedian’s structure-process-outcome quality of care model: validation in an integrated trauma system. J Trauma Acute Care Surg. 2015; 78(6):1168–75. doi: 10.1097/TA.0000000000000663.

Moore L, Lavoie A, Sirois MJ, et al. A comparison of methods to obtain a composite performance indicator for evaluating clinical processes in trauma care. J Trauma Acute Care Surg. 2013;74(5):1344-50. doi: 10.1097/TA.0b013e31828c32f2.

Moore L, Turgeon AF, Sirois MJ, et al. Trauma centre outcome performance: a comparison of young adults and geriatric patients in an inclusive trauma system. Injury. 2012;43(9):1580- 5. doi: 10.1016/j.injury.2011.02.010.

Myers SR, Branas CC, French B, et al. A National Analysis of Pediatric Trauma Care Utilization and Outcomes in the United States. Pediatr Emerg Care. 2019;35(1):1-7. doi: 10.1097/ PEC.0000000000000902.

Sathya C, Alali AS, Wales PW, et al. Mortality Among Injured Children Treated at Different Trauma Center Types. JAMA Surg. 2015;150(9):874-81. doi: 10.1001/jamasurg.2015.1121.

Sørup CM, Jacobsen P, Forberg JL. Evaluation of emergency department performance–a systematic review on recommended performance and quality-in-care measures. Scand J Trauma Resusc Emerg Med. 2013;21(1):1–14. doi: 10.1186/1757-7241-21-62.

Strudwick K, Russell T, Bell AJ, et al. Musculoskeletal injury quality outcome indicators for the emergency department. Intern Emerg Med. 2020;15(3):501-14. doi: 10.1007/ s11739-019-02234-w.

Udyavar NR, Salim A, Havens JM, et al. The impact of individual physicians on outcomes after trauma: is it the system or the surgeon? J Surg Res. 2018;229:51-7. doi: 10.1016/j. jss.2018.02.051.

Van Ditshuizen JC, Van Den Driessche CRL, Sewalt CA, et al. The association between level of trauma care and clinical outcome measures: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2020;89(4):801-12. doi: 10.1097/ TA.0000000000002850.

Apodaca A, Olson CM Jr, Bailey J, et al. Performance improvement evaluation of forward aeromedical evacuation platforms in Operation Enduring Freedom. J Trauma Acute Care Surg. 2013;75(Suppl. 2):S157-63. doi: 10.1097/ TA.0b013e318299da3e.

Bossers SM, Schwarte LA, Loer SA, et al. Experience in Prehospital Endotracheal Intubation Significantly Influences Mortality of Patients with Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. PLoS One. 2015;10(10):1-26. doi: 10.1371/journal.pone.0141034.

Brinck T, Raj R, Skrifvars MB, et al. Unconscious trauma patients: outcome differences between southern Finland and Germany-lesson learned from trauma-registry comparisons. Eur J Trauma Emerg Surg. 2016;42(4):445-51. doi: 10.1007/s00068-015-0551-7.

Curtis K, Chong S, Mitchell R, et al. Outcomes of severely injured adult trauma patients in an Australian health service: does trauma center level make a difference? World J Surg. 2011;35(10):2332-40. doi: 10.1007/s00268-011-1217-1.

Endo H, Fushimi K, Otomo Y. The off-hour effect in severe trauma and the structure of care delivery among Japanese emergency and critical care centers: A retrospective cohort study. Surgery. 2020;167(3):653-60. doi: 10.1016/j.surg.2019.10.014.

Gitelman V, Auerbach K, Doveh E. Development of road safety performance indicators for trauma management in Europe. Accid Anal Prev. 2013;60:412-23. doi: 10.1016/j.aap.2012.08.006.

Gough BL, Painter MD, Hoffman AL, et al. Right Patient, Right Place, Right Time: Field Triage and Transfer to Level I Trauma Centers. Am Surg. 2020;86(5):400-6. doi: 10.1177/ 0003134820918249.

Gleich SJ, Bennett TD, Bratton SL, et al. Pediatric trauma transport performance measures in a mountain state: adherence and outcomes. J Trauma. 2011;71(4):1016-22. doi: 10.1097/TA.0b013e31820500fe.

Gurien LA, Chesire DJ, Koonce SL, et al. An evaluation of trauma outcomes related to insurance status in patients requiring prehospital helicopter transport. Prehosp Disaster Med. 2015;30(1):62-5. doi: 10.1017/S1049023X14001253.

Haas B, Stukel TA, Gomez D, et al. The mortality benefit of direct trauma center transport in a regional trauma system: a population-based analysis. J Trauma Acute Care Surg. 2012; 72(6):1510-5. doi: 10.1097/TA.0b013e318252510a.

Huh Y, Kwon J, Moon J, et al. An Evaluation of the Effect of Performance Improvement and Patient Safety Program Implemented in a New Regional Trauma Center of Korea. J Korean Med Sci. 2021;36(22):e1-13. doi: 10.3346/jkms.2021.36.e149.

Khoury A, Weil Y, Liebergall M, et al. Outcome of femoral fractures care as a measure of trauma care between level I and level II trauma systems in Israel. Trauma Surg Acute Care Open. 2016;1(1):e1-4. doi: 10.1136/tsaco-2016-000041.

Maddry JK, Mora AG, Savell S, et al. Combat MEDEVAC: A comparison of care by provider type for en route trauma care in theater and 30-day patient outcomes. J Trauma Acute Care Surg. 2016;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S104-10. doi: 10.1097/ TA.0000000000001119.

Newgard CD, Fu R, Bulger E, et al. Evaluation of Rural vs Urban Trauma Patients Served by 9-1-1 Emergency Medical Services. JAMA Surg. 2017;152(1):11-8. doi: 10.1001/ jamasurg.2016.3329.

Smith AA, Ochoa JE, Wong S, et al. Prehospital tourniquet use in penetrating extremity trauma: Decreased blood transfusions and limb complications. J Trauma Acute Care Surg. 2019;86(1):43-51. doi: 10.1097/TA.0000000000002095.

Moore L, Stelfox HT, Turgeon AF. Complication rates as a trauma care performance indicator: a systematic review. Crit Care. 2012;16(5):1-10. doi: 10.1186/cc11680.

Sutherland M, Ehrlich H, McKenney M, et al. Trauma out-comes for blunt and penetrating injuries by mode of transportation and day/night shift. Am J Emerg Med. 2021;48:79-82. doi: 10.1016/j.ajem.2021.04.012.

Walther AE, Pritts TA, Falcone RA, et al. Teen trauma without the drama: outcomes of adolescents treated at Ohio adult versus pediatric trauma centers. J Trauma Acute Care Surg. 2014; 77(1):109-16. doi: 10.1097/TA.0000000000000277.

Wandling MW, Nathens AB, Shapiro MB, et al. Association of Prehospital Mode of Transport With Mortality in Penetrating Trauma: A Trauma System-Level Assessment of Private Vehicle Transportation vs Ground Emergency Medical Services. JAMA Surg. 2018;153(2):107-13. doi: 10.1001/ jamasurg.2017.3601.

Waxman K, Izfar S, Grotts J. The mortality risk from motor vehicle injuries in California has increased during the last decade. J Trauma Acute Care Surg. 2012;73(3):716-20. doi: 10.1097/TA.0b013e31825c14e2.

Lee DW, Moon HJ, Heo NH. Association between ambulance response time and neurologic outcome in patients with cardiac arrest. Am J Emerg Med. 2019;37(11):1999-2003. doi: 10.1016/j.ajem.2019.02.021.

Bürger A, Wnent J, Bohn A, et al. The Effect of Ambulance Response Time on Survival Following Out-of-Hospital Cardiac Arrest. Dtsch Arztebl Int. 2018;115(33-34):541-8. doi: 10.3238/arztebl.2018.0541.

Aluisio AR, Waheed S, Cameron P, et al. Clinical emergency care research in low-income and middle-income countries: opportunities and challenges. BMJ Glob Health. 2019;4(Suppl. 6):1-8. doi: 10.1136/bmjgh-2018-001289.

Al-Shaqsi S. Models of International Emergency Medical Service (EMS) Systems. Oman Med J. 2010;25(4):320-3. doi: 10.5001/omj.2010.92.

Eiche C, Birkholz T, Konrad F, et al. Job Satisfaction and Performance Orientation of Paramedics in German Emergency Medical Services-A Nationwide Survey. Int J Environ Res Public Health. 2021;18(23):1-12. doi: 10.3390/ijerph182312459.

Schneider A, Weigl M. Associations between psychosocial work factors and provider mental well-being in emergency departments: A systematic review. PLoS One. 2018 Jun;13(6):2- 22. doi: 10.1371/journal.pone.0197375.

World Health Organization. Global Plan Decade of Action for Road Safety 2021–2030 [Internet]. World Health Organization. 2021[cited 2023]:p.36. Available on: https://cdn.who.int/media/ docs/default-source/documents/health-topics/road-traffic-injuries/global-plan-for-road-safety.pdf?sfvrsn=65cf34c8_35&do wnload=true.

GBD 2017 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1859- 922. doi: 10.1016/S0140-6736(18)32335-3.

Organización Mundial de la Salud. Informe mundial sobre la discapacidad; 2011. Disponible: https://apps.who.int/iris/ handle/10665/75356.

Naciones Unidas. Resolución aprobada por la Asamblea General el 25 de septiembre de 2015 [Internet]. 21 de octubre del 2015. Nueva York: Naciones Unidas; 2015. Disponible en: https://unctad.org/system/files/official-document/ares70d1_ es.pdf.

Naciones Unidas. Resolución aprobada por la Asamblea General el 31 de agosto de 2020 [Internet]. Ginebra: OMS; 2020 [citado 2023]. Disponible en: https://undocs.org/es/A/ RES/74/299.

Organización Mundial de la Salud. Atención básica de emergencia: abordaje de lesionados y enfermos agudos [Internet]. Ginebra: OMS; 2018 [citado 2023]. Disponible en: https:// www.who.int/es/publications/i/item/basic-emergency-care-approach-to-the-acutely-ill-and-injured.

Havermans RJ, de Jongh MA, Bemelman M, van Driel APG, Noordergraaf GJ, Lansink KW. Trauma care before and after optimisation in a level I trauma Centre: Life-saving changes. Injury. 2019;50(10):1678–83. 10.1016/j.injury.2019.07.017.

Matsushima K, Schaefer EW, Won EJ, Nichols PA, Frankel HL. Injured adolescents, not just large children: difference in care and outcome between adult and pediatric trauma centers. Am Surg. 2013;79(3):267–73.

Moore L, Lavoie A, Bourgeois G, Lapointe J. Donabedian’s structure-process-outcome quality of care model: validation in an integrated trauma system. J Trauma Acute Care Surg. 2015;78(6):1168–75. DOI: 10.1097/TA.0000000000000663.

Gough BL, Painter MD, Hoffman AL, Caplan RJ, Peters CA, Cipolle MD. Right patient, right place, right time: field triage and transfer to Level I trauma centers. Am Surg. 2020;86(12):1697– 702. DOI: 10.1177/0003134820918249.

Khoury A, Weil Y, Liebergall M, Mosheiff R. Outcome of femoral fractures care as a measure of trauma care between level I and level II trauma systems in Israel. Trauma Surg acute care open. 2016;1(1): e000041. Doi: 0.1136/tsaco-2016-000041.

Smith AA, Ochoa JE, Wong S, Beatty S, Elder J, Guidry C, McGrew P, McGinness C, Duchesne J, Schroll R. Prehospital tourniquet use in penetrating extremity trauma: decreased blood transfusions and limb complications. J Trauma Acute Care Surg. 2019;86(1):43–51. DOI: 10.1097/ TA.0000000000002095.




DOI (PDF): https://doi.org/10.24875/10.5281/zenodo.10064412

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