Quality of Care Management among Persons with Multiple Trauma at Emergency Department in a Tertiary Care Hospital under the Ministry of Public Health

Abstract

This descriptive research aimed to study the quality of care for multiple trauma patients in the emergency and accident department using the Donabedian model as a conceptual framework. The sample consisted of 83 medical records of multiple trauma patients and 32 professional nurses. The data collection tools were divided into three aspects: structure, process, and outcome. Data were analyzed using descriptive statistics and inferential statistics with the Mann-Whitney U test.

          The results showed that, in terms of patient characteristics, the majority were male, with an average age of 38.52 years (SD=14.94), and most injuries resulted from traffic accidents. Regarding healthcare providers, most nurses were female, with an average age of 32.19 years (SD=1.40), held a bachelor’s degree (96.88 %), and had an average work experience of 8.28 years (SD=7.68). Overall, their knowledge of multiple trauma patient care was at a high level (62.50 %), and there was no significant difference in knowledge of care management among persons with multiple trauma between those who had attended specialized training and those who had not (p>0.05).

          For the process of care, during the pre-hospital care phase, emergency response teams took less than 2 minutes to respond, and patients had a Glasgow Coma Score (GCS) of <8 (58.62 %). In the in-hospital care phase, (100 %) received activated fast track trauma protocols, and approximately half did not experience hemorrhagic shock. In the definitive care phase, most patients underwent surgery within 30 minutes (63.64 %) and were transferred to critical care units, with an average emergency room stay of 290.83 minutes (SD=153.02).

          In terms of outcomes, 89.15 % of patients survived. Among those with a low probability of survival (Ps<0.25), 77.78 % died, while 16.67 % of patients in the preventable death group (Ps 0.51-0.74) did not survive. The findings reflect a certain level of quality in the care provided to multiple trauma patients. However, further development of care protocols is recommended to improve the survival rates of patients whose deaths could potentially be prevented.