Trauma center volume and quality improvement programs

J Trauma Acute Care Surg. 2012 Apr;72(4):962-7. doi: 10.1097/TA.0b013e31824a7bd8.


Background: Growing evidence suggests that for many treatments, a relationship exists between provider volume and patient outcomes. This relationship is less clear in injury management. We sought to evaluate whether a relationship exists between trauma center volume and the nature of quality improvement (QI) programs.

Methods: This is a survey of 154 verified adult trauma centers in the United States, Canada, Australia, and New Zealand (76% response rate) regarding their QI programs. Centers were classified according to American College of Surgeons annual volume requirements for a Level I center (low volume vs. high volume) and QI programs compared.

Results: All participating trauma centers reported using a trauma registry and measuring quality of care. Low-volume centers were more likely than high-volume centers to use quality indicators for evaluating triage and patient flow (18% vs. 13%, p < 0.001), effectiveness of care (33% vs. 30%, p = 0.016), and efficiency of care (29% vs. 23%, p < 0.001). High-volume centers were more likely to use quality indicators for evaluating medical errors and adverse events (30% vs. 36%, p < 0.001) and the use of guidelines/protocols (2% vs. 3%, p = 0.001). Report cards (41% vs. 59%, p = 0.025) and internal benchmarking (79% vs. 91%, p = 0.040) were less frequently reported to be used by low-volume than high-volume centers.

Conclusions: Both low- and high-volume centers reported being engaged in QI. Small differences in the types of quality indicators used by centers were observed according to volume, with high-volume centers more likely than low-volume centers to use report cards and benchmarking as QI tools.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Australia
  • Canada
  • Health Care Surveys
  • Humans
  • Injury Severity Score
  • New Zealand
  • Outcome and Process Assessment, Health Care
  • Quality Improvement / standards
  • Quality Improvement / statistics & numerical data*
  • Quality Indicators, Health Care / standards
  • Quality Indicators, Health Care / statistics & numerical data
  • Quality of Health Care
  • Trauma Centers / standards*
  • Trauma Centers / statistics & numerical data
  • United States
  • Wounds and Injuries / epidemiology
  • Wounds and Injuries / therapy