Objective: To design and implement a hospital trauma registry so as to be able to monitor the care of injured patients.
Setting: Teaching hospital, Greece.
Subjects: All patients admitted with trauma from January 1997.
Main outcome measures: Design of a suitable form, establishment of inclusion and exclusion criteria, injury severity scoring, finding money and personnel, and getting suitable computer hardware and software for reliable collection and analysis of data.
Results: We experienced great difficulty in getting funding, so were unable to employ dedicated staff to collect the data, though we have had a part-time secretary to coordinate the registry whose salary has been paid by a pharmaceutical company. We have to rely on junior doctors to collect the data, which works well when they are enthusiastic (though not all are). We decided to use the data collection form used by the UK Trauma Network. We are trying to collect sufficient data to code severity by more than one system, but at present this is causing problems because busy nurses and doctors do not like filling in forms. Software has also been a problem as most of it is in English and translation is a considerable workload. The calculations are still being done manually while we work with two computer programmers to develop our own. We have submitted a research protocol to the Ministry of Health which has been accepted and this will guarantee our expenses for the next two years.
Conclusions: Implementing a philosophy of continuous quality improvement is never easy, and we expect funding to be a permanent source of anxiety. Our progress so far has been good, but not as good as we hoped; however, we are optimistic that as people see the value of continuous monitoring of the system they will become more enthusiastic and supportive.