• Steffen Ruchholtz, Christian Waydhas, Ulrike Lewan, Karl Piepenbrink, Dietmar Stolke, Jörg Debatin, Leonhard Schweiberer, and Dieter Nast-Kolb.
• Department of Trauma Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany. steffen.ruchholtz@uni-essen.de
• Intensive Care Med. 2002 Oct 1;28(10):1395-404.

ObjectiveThe impact of a multidisciplinary quality management system (MQMS) on the early treatment of severely injured patients was tested.Design And SettingProspective clinical study in two level 1 trauma centers.Methods And MaterialsMQMS comprised a protocol for documentation, 20 assessment criteria, and the judgement of data by a quality circle. After implementation in Munich (1st period, n=90; 2nd period, n=77) the validation took place in Essen (1st period, n=175; 2nd period, n=150).ResultsImprovements in diagnostics were shown by significant time savings in radiological diagnostics and before computed tomography in severe traumatic brain injury. In patients with hemorrhagic shock there was a reduction in time before transfusion (49 to 14 min in Munich; 31 to 22 min in Essen) and before emergency operation (74 to 43 min in Munich; 69 to 45 min in Essen). The time before craniotomy was reduced from 97 to 67 min in Munich. The incidence of delayed diagnosis of life-threatening lesions was diminished from 6% to 3% in Munich (not found in Essen). The TRISS technique showed a reduction in mortality in both hospitals in the second period (Munich: 15.4% TRISS vs. 9.1% observed mortality; Essen: 17.8% vs. 11.3%).ConclusionsMQMS improved early clinical treatment in severe injury with respect to therapeutic effectiveness and outcome. The effectiveness of the MQMS was shown at two different hospitals

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