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Quality assurance in the Department of Trauma Surgery

An essential task of all medical treatment is to achieve an individual and optimal result for the individual patient. We not only participate in recommended quality control and quality assurance measures, but also try to improve our work with intra- and inter-departmental quality measures by constantly and critically reviewing our work on a daily basis.


Departmental quality management

Internal training

1. Mortality and morbidity conference (M&M)
The Department of Trauma Surgery at University Hospital Zurich has set up a special mortality and morbidity conference (M&M) to improve internal processes and discuss any complications that have arisen. This is a platform for re-evaluating intra-departmental treatment procedures and complications presented in processed form and for applying possible improvements to everyday clinical practice – also in the context of the latest scientific findings.

2. Critical Incident Reporting System (CIRS)
As a modern trauma centre, we use the critical incident reporting system, CIRS for short. This facilitates the anonymous reporting of critical incidents and near misses.

3. Infectiology-traumatology board
The infectiology-traumatology board was formed in March 2018.
The purpose of this new initiative is to increase patient management quality in the case of patients who are at risk or already showing signs of trauma-related infections of the bone and soft tissue.

Procedure
Doctors from both clinics who have reached various levels of training meet once a week for personal discussions of patients with complex infectiological problems following traumatic injuries. These meetings also address the development of treatment plans for inpatients and outpatients, thus ensuring that they receive appropriate follow-up care.

Expertise
A common knowledge base has been created to advance the further training of junior doctors; this includes the USZ guidelines on “Initial Antimicrobial Treatment” and the following reference work:
“Infektionen des Bewegungsapparates: Grundlagen, Prophylaxe, Diagnostik und Therapie [Infections of the Musculoskeletal System: Principles, Prophylaxis, Diagnostics and Therapy]”. 2nd revised and expanded edition, 2016. Edited by the “Infections of the Musculoskeletal System” Expert Group of Swiss Orthopaedics and the Swiss Society for Infectious Diseases, published in-house by swiss orthopaedics. At least one traumatology expert and one infectiology expert specialising in bone and implant-related infections will be on the board. This will ensure that patients in both inpatient and outpatient settings receive ongoing, flexible, individually adapted care from experts at University Hospital Zurich.

Both clinics are highly motivated and pleased to be cooperating still more closely for the good of our patients.

4. “Basic Life Support”
This is a learning unit for all doctors who work at University Hospital Zurich. Along with practical exercises, this course requires participants to pass a final test (at least 80% of answers must be correct).

5. Standard Operating Procedures (SOP)
The Department of Trauma Surgery has developed standardised treatment recommendations known as SOPs (“Standard Operationg Procedures”) which define standard treatment procedures for all common injuries; these can be accessed by all staff.

6. In-service training with Balgrist University Hospital
An in-service training event takes place at University Hospital Zurich every month in cooperation with the Department of Orthopaedics at Balgrist University Hospital, Zurich.

7. USZ trauma board
The trauma board at University Hospital Zurich reviews difficult cases retrospectively and discusses them with the other departments involved in their treatment so that common experiences – both positive and negative – can flow into and improve the treatment given to severely injured patients in the future.

External training

1. Complications management and external quality assurance
As a university hospital, we specialise in the treatment of complicated cases. These include the treatment of complex defects and infections in the bone and soft tissue. The hospital also participates in quality control and assurance measures. These include the implementation of external quality assurance procedures (SIRIS) when treating fractures in the vicinity of the hip, inserting implants and changing hip endoprostheses after a trauma.

2. Safe Surgery – Time out
Moreover, our procedures in the operating theatre comply with the standard developed by the international WHO project “Action on Patient Safety: High 5s” and apply the treatment principle of safe surgery.
The World Health Organization (WHO) initiated the High 5s project in 2006 with the goal of addressing concerns surrounding the internationally important topic of patient safety. The term “High 5s” is derived from the project’s original intention of reducing 5 serious patient safety problems in 5 countries over a period of 5 years.

Certification, centre activities

1. Certification as a supra-regional trauma centre
In addition to our intra-departmental procedures, we also cooperate with various specialised committees such as the Swiss Trauma Registry; the Emergency Medicine, Intensive Care and Trauma Management Section; and the “Spine” working group of the German Society of Trauma Surgery. We also contribute to the DGUR Trauma Register of the German Society of Trauma Surgery.

2.  Schwerverletzenversorgung der SchweizCertified supra-regional trauma centre / HSM centre for the treatment of severely injured patients in Switzerland
University Hospital Zurich is actively contributing to the formation of networks in Switzerland. As a supra-regional trauma centre, the Department of Trauma Surgery has been part of the cross-border trauma network Traumanetzwerk Schwarzwald-Bodensee since 2009. In the context of the Intercantonal Agreement on Highly Specialised Medicine, it was decided that adult patients with severe injuries and patients with severe traumatic brain injury would only be treated at 12 specific centres; one of these is University Hospital Zurich, which has a very high number of national and international cases.

3. Swiss Trauma Board

In 2015, the 12 designated centres decided to form a single organisation with the name of “Swiss Trauma Board” for the purpose of keeping a register and setting up a coordination centre for reporting to IVHSM organs. Our involvement in several Swiss Trauma Board projects reflects our commitment to the advancement of medical care for severely injured patients in Switzerland. www.swisstraumaboard.ch

Resolution concerning the assignment of severely injured patients to institutions providing highly-specialised medicine (HSM):

After reviewing the application submitted by the expert HSM body at the meeting held on 17 September 2015, the decision-making body of the Intercantonal Agreement on Highly Specialised Medicine (HSM decision-making body), based on Article 39 paragraph 2 of the Swiss Federal Health Insurance Act (KVG) and Article 3 paragraphs 3–5 of the Intercantonal Agreement on Highly Specialised Medicine (IVHSM), passed the following resolution: The treatment of severely injured patients shall be assigned to providers of highly specialised medicine.

The patient group in question encompasses:

• Adults with one or more severe, life-threatening injuries with an Injury Severity Score (ISS) of at least 20 points
• Adults with severe traumatic brain injury (AIS head ≥3)

The resolution is an integral part of the hospital list drawn up jointly by the participating cantons in accordance with Article 39 KVG in conjunction with Article 3 paragraph 4 IVHSM and forms the basis for decisions regarding planning and allocation in the designated area.

4. Geriatric Traumatology / Centre for Geriatric Traumatology (ATZ)
Please see the separate section on our website at:
Services: Geriatric Traumatology / Centre for Geriatric Traumatology (ATZ)

To the certification

5. Spine Centre

The Department of Trauma Surgery (accident surgery) is a co-founder of the USZ Spine Centre.

Along with the core departments (Department of Neurosurgery, Department of Rheumatology, Department of Trauma Surgery (accident surgery)) and the physiotherapy and occupational therapy departments, the Spine Centre cooperates closely with numerous hospitals and institutions.

Courses and in-service training

1. Shock room simulation training
Once a month, an all-day simulation training session is held in the learning centre and shock room at University Hospital Zurich in cooperation with anaesthesiologists and nursing staff from the Emergency Surgery and Anesthesiology departments.

2. ATLS / ETC courses

The Department of Trauma Surgery actively supports the early training of its junior doctors in ATLS and ETC course formats. Several of our staff serve as supra-regional and international course directors and instructors besides facilitating the courses delivered at University Hospital Zurich.

Information/registration for ATLS “Zurich” courses through the “Local Director Zurich” “ATLS Switzerland”: PD Dr Valentin Neuhaus, Chief Physician, email: valentin.neuhaus@usz.ch.
Further information: www.atls.ch

3. DSTC: Definitive Surgical Trauma Care

The DSTCTM concept was developed some years ago by the International Association for Trauma and Surgical Intensive Care (IATSIC) with the aim of realistically simulating the first surgical phase following the treatment received in the shock room. This gives our advanced physicians the opportunity to undergo exceptionally practice-oriented surgical training and benefit from a course that will help them make decisions quickly.
www.dgu-online.de

4. Interdisciplinary polytrauma course in Zurich with simulation training and polytrauma course (DGU, DGOU, ESTES, SICOT)

4.1 Polytrauma course at University Hospital Zurich with simulation training

This two-day course has been held once a year since 2011. It consists of practical exercises for managing acute cases, video analysis of a shock room procedure, practical analysis of an acute pelvic stabilisation under surgical conditions, and a test on the second day.
This course is suitable for external doctors from their 3rd year of training upwards and for internal medical staff.
It is an interdisciplinary course intended for specialists in the fields of anaesthesiology, surgery, intensive care, radiology and emergency medicine along with anyone else who may be interested.

To the event

4.2. Polytrauma course (DGU, DGOU, ESTES, SICOT)

This course has been delivered since 2002 in cooperation with various professional associations (German Society of Surgery, German Society of Trauma Surgery, SICOT and ESTES). It consists of two days of attendance and a test. It is UEM-certified. The course is intended for specialists in various disciplines (trauma surgery, intensive care, neurosurgery, visceral surgery): experienced junior physicians (from their 4th year in training), senior physicians, specialists in emergency medicine and paramedics.
Further information including registration: www.polytraumacourse.com.

Upcoming courses are also listed on this website under “Events”.

5. Trauma courses for junior and senior physicians undergoing in-service training

OTC stands for “Osteosynthesis and Trauma Care”. OTC Germany, previously known as AIOD, is a body that facilitates the national and international exchange of experience in the areas of trauma surgery and orthopaedics. Other central tasks and goals include the provision of support for junior scientists and the education and training of specialist physicians. OTC (comprising the management board and working groups) forms the basis of the entire range of courses available to doctors and surgical staff in the fields of arthroscopy, foot surgery, spinal surgery and many others.

The courses take place on the island of Sylt and in Alpbach (Tyrol). Participants approx. 100

Scientific topics: trauma of the extremities, geriatric traumatology, paediatric traumatology
Course structure: Mornings: presentations by experts, tips and tricks, interactive discussion Afternoons: hands-on workshops including the insertion of implants in plastic bones, interactive seminars with case discussions.

6. Congresses, scientific journals
Clinical experience is also published in scientific books and journals and shared at scientific congresses and advanced training events in Switzerland and abroad.