Organising the care of severely injured patients
Polytraumatised patients are still a challenge. In order to improve the quality of the care given to patients with severe injuries, it was decided in the Intercantonal Agreement on Highly Specialised Medicine of 20 May 2011 that adult patients with severe injuries and patients with severe traumatic brain injury would henceforth only be treated at 12 specific centres. One of these is University Hospital Zurich, which deals with a high volume of national and international cases. The formation of networks was recommended, and the first Swiss national network was established in central Switzerland in 2016. The Department of Trauma Surgery has been a member of Traumanetzwerk Schwarzwald-Bodensee (the Black Forest/Lake Constance trauma network) since 2009. The purpose of the networks is to bundle all the expertise of the emergency services, doctors and hospitals that provide patient care in the region and ensure that it is used efficiently.
All those involved work together in a spirit of partnership, e.g. to fix criteria with which it can be determined whether a patient can be treated at their local hospital or should be transferred to a supraregional HSM centre. Such decisions will be facilitated by the establishment of telecommunication systems connecting emergency services and hospitals, which will allow x-ray images to be transmitted within just a few minutes, for example. Regular joint advanced training and continuing education programmes, the development of standards of treatment, case conferences, and quality circles all facilitate a continuous improvement process. Members have voluntarily undertaken to have the quality of the treatment administered to severely injured patients assessed by recording their cases in the DGUR Trauma Register and having them reviewed by external appraisers; this constitutes part of the certification process of the Deutsche Gesellschaft für Unfallchirurgie (German Society for Trauma Surgery). The HSM hospitals have come together to form the Swiss Trauma Board and set up the Swiss Trauma Registry for their patients. Cooperating with the DGUR Trauma Register facilitates quality comparisons not only between HMS hospitals but also with a large collective from the German Trauma Register. The collection of data by the Swiss Trauma Registry is also regularly reviewed by external appraisers.