The Impact of a Pan-regional Inclusive Trauma System on Quality of Care

Ann Surg. 2016 Jul;264(1):188-94. doi: 10.1097/SLA.0000000000001393.


Objectives: To evaluate the impact of the implementation of an inclusive pan-regional trauma system on quality of care.

Background: Inclusive trauma systems ensure access to quality injury care for a designated population. The 2007 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found quality deficits for 60% of severely injured patients. In 2010, London implemented an inclusive trauma system. This represented an opportunity to evaluate the impact of a pan-regional trauma system on quality of care.

Methods: Evaluation of the London Trauma System (ELoTS) utilized the NCEPOD study core methodology. Severely injured patients were identified prospectively over a 3-month period. Data were collected from prehospital care to 72 h following admission or death. Quality, processes of care, and outcome were assessed by expert review using NCEPOD criteria.

Results: Three hundred and twenty one severely injured patients were included of which 84% were taken directly to a major trauma center, in contrast to 16% in NCEPOD. Overall quality improved with the proportion of patients receiving "good overall care" increasing significantly [NCEPOD: 48% vs ALL-ELoTS: 69%, RR 1.3 (1.2 to 1.4), P < 0.01], primarily through improvements in organizational processes rather than clinical care. Improved quality was associated with increased early survival, with the greatest benefit for critically injured patients [NCEPOD: 31% vs All-ELoTS 11%, RR 0.37 (0.33 to 0.99), P = 0.04].

Conclusions: Inclusive trauma systems deliver quality and process improvements, primarily through organizational change. Most improvements were seen in major trauma centers; however, systems implementation did not automatically lead to a reduction in clinical deficits in care.

MeSH terms

  • Adult
  • Female
  • Humans
  • Injury Severity Score
  • London
  • Male
  • Middle Aged
  • Multiple Trauma / therapy*
  • Quality of Health Care / standards*
  • Trauma Centers / organization & administration*
  • Triage / organization & administration*