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Open Access Research article

Developing process guidelines for trauma care in the Netherlands for severely injured patients: results from a Delphi study

Elisabeth Maria Hoogervorst126*, Eduard Ferdinand van Beeck3, Johan Carel Goslings4, Pieter Dirk Bezemer5 and Joost Jan Laurens Marie Bierens1

Author affiliations

1 Department of Anaesthesiology, VU University Medical Center, Amsterdam, the Netherlands

2 Current address: Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands

3 Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands

4 Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands

5 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands

6 Simon van Ooststroomhof 1, Oegstgeest, 2341 KE, the Netherlands

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Citation and License

BMC Health Services Research 2013, 13:79  doi:10.1186/1472-6963-13-79

Published: 3 March 2013

Abstract

Background

In organised trauma systems the process of care is the key to quality. Nevertheless, the optimal process of trauma care remains unclear due to lack of or inconclusive evidence. Because monitoring and improving the performance of a trauma system is complex, this study aimed to develop consensus-based process guidelines for trauma care in the Netherlands for severely injured patients.

Methods

A five-round Delphi study was conducted with 141 participants that represent all professions involved in trauma care. Sensitivity analyses were carried out to evaluate whether consensus extended across all professions and to detect possible bias.

Results

Consensus was reached on 21 guidelines within 4 categories: timeliness, actions, competent teams and interdisciplinary process. Timeliness guidelines set specific critical limits and definitions for 10 time intervals in the time period from an emergency call until the patient leaves the trauma room. Action guidelines reflect aspects of appropriate care and strongly rely on the international Advanced Trauma Life Support principles. Competence guidelines include flow charts to assess the competence of prehospital and emergency department teams. Essential to competent teams are education and experience of all team members. The interdisciplinary process guideline focuses on cooperation, communication and feedback within and between all professions involved. Consensus was extended across all professions and no bias was detected.

Conclusions

In this Delphi study, a large expert panel agreed on a set of guidelines describing the optimal process of care for severely injured trauma patients in the Netherlands. In addition to time intervals and appropriate actions, these guidelines emphasise the importance of team competence and interdisciplinary processes in trauma care. The guidelines can be seen as a description of a best practice and a new field standard in the Netherlands. The next step is to implement the guidelines and monitor the performance of the Dutch trauma system based on the guidelines.