Audit filters for improving trauma care

Major injuries are a significant cause of death and decreased quality of life worldwide. Previous research has shown that when severely injured patients are managed in an organized system of care that includes treatment by paramedics, transportation to a hospital that has specialist doctors available to treat their injuries, and additional health personnel to help them to rehabilitate, patients are more likely to survive and suffer fewer disabilities.

There are a number of ways that the quality of care provided to injured patients in a trauma system can be determined and improved. Trauma audit filters are descriptions of specific actions that should be taken, timeframes in which tests or treatments should be provided, or outcomes that are expected to occur in injured patients. Reviewing the charts of patients whose care deviates from that described by an audit filter and providing feedback to the clinicians involved in that patient's care is expected to provide a means of correcting errors and improving future performance.

Our study tried to determine how effective audit filters are at improving trauma care.

We were unable to find any studies to include in the review. More studies are needed to determine if audit filters are effective in improving care and, if they are, how effective they are in comparison to other quality improvement strategies.

Authors' conclusions: 

We were unable to identify any studies of sufficient methodological quality to draw conclusions regarding the effectiveness of audit filters as a performance improvement intervention in trauma systems. Future research using rigorous study designs should focus on the relative effectiveness of audit filters in comparison to alternative quality improvement strategies at improving processes of care, functional outcomes, and mortality for injured patients.

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Background: 

Traumatic injuries represent a considerable public health burden with significant personal and societal costs. The care of the severely injured patient in a trauma system progresses along a continuum that includes numerous interventions being provided by a multidisciplinary group of healthcare personnel. Despite the recent emphasis on quality of care in medicine, there has been little research to direct trauma clinicians and administrators on how optimally to monitor and improve upon the quality of care delivered within a trauma system. Audit filters are one mechanism for improving quality of care and are defined as specific clinical processes or outcomes of care that, when they occur, represent unfavorable deviations from an established norm and which prompt review and feedback. Although audit filters are widely utilized for performance improvement in trauma systems they have not been subjected to systematic review of their effectiveness.

Objectives: 

To determine the effectiveness of using audit filters for improving processes of care and clinical outcomes in trauma systems.

Search strategy: 

Our search strategy included an electronic search of the Cochrane Injuries Group Specialized Register, the Cochrane EPOC Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 4), MEDLINE, PubMed, EMBASE, CINAHL, and ISI Web of Science: (SCI-EXPANDED and CPCI-S). We handsearched the Journal of Trauma, Injury, Annals of Emergency Medicine, Academic Emergency Medicine, and Injury Prevention. We searched two clinical trial registries: 1) The World Health Organization International Clinical Trials Registry Platform and, 2) Clinical Trials.gov. We also contacted content experts for further articles. The most recent electronic search was completed in December 2008 and the handsearch was completed up to February 2009.

Selection criteria: 

We searched for randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series studies that used audit filters as an intervention for improving processes of care, morbidity, or mortality for severely injured patients.

Data collection and analysis: 

Two authors independently screened the search results, applied inclusion criteria, and extracted data.

Main results: 

There were no studies identified that met the inclusion criteria for this review.

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