Trauma
Care Continuum

TCC

Trauma Care Continuum (TCC)

History

The manner in which accident victims receive initial care and are treated has developed to a large extent over the last thirty years. The experience yielded by modern armed conflicts, new testing technologies and recent scientific studies has led to a better understanding of the causes of death due to trauma and ways to reduce subsequent mortality and morbidity. All modern societies have acknowledged that the best way to improve the survival of accident victims is to reduce waiting times for access to necessary services and care.

In 1984, the Société de l’assurance automobile du Québec (SAAQ) financed a study, the results of which advocated use of an integrated approach to care for victims of head trauma. In 1987, with the approval of the Ministère de la Santé et des Services sociaux (MSSS), the SAAQ signed agreements with a number of rehabilitation care facilities, resulting in the emergence of highly specialized care in some of these rehabilitation facilities.  In 1991, these agreements were extended to early rehabilitation services that were available in some hospital centres specialized in neurotrauma. They were broadened again in 1997 to include spinal cord injury victims, and once again in 2000 to include services to victims of severe orthopedic injuries.

The Trauma Services Advisory Group

In the early 1990’s, the Ministère de la Santé et des Services sociaux (MSSS) mandated the Société de l’assurance automobile du Québec (SAAQ) to organize the province’s trauma care and services network.

  • 1992: The SAAQ created a Trauma Services Advisory Group.
  • 1992: Using a matrix approach, the Trauma Services Advisory Group assessed the health care institution network through an external audit and recommended the designation of certain institutions to create a trauma centre network.
  • 1995: The Trauma Services Advisory Group reassessed the relevance of maintaining designations based on the matrix approach used in 1992.
  • 1997: The Trauma Services Advisory Group took on the mandate to assess two expert care centres for patients with spinal cord injuries and to incorporate an evaluation of the Rehabilitation component (involving program content and standards for quality of care) into the assessment matrix used. In addition to the Trauma Services Advisory Group’s existing Physical Health component, a Rehabilitation/Support for Social Participation component was added.
  • 1998–99: The Trauma Services Advisory Group carried out a third external audit mandate with a view to consolidating the trauma network by implementing, at each designated institution in the network, a specific trauma care and services program, the complete and standardized trauma care procedures applicable to all centres, and a continuous quality improvement program.
  • 1999: The MSSS commissioned the Trauma Services Advisory Group (Rehabilitation/Support for Social Participation component) to carry out its first mandate: evaluating rehabilitation facilities that provided care and services for individuals who had sustained moderate-to-severe trauma brain injuries (TBI). This was the first phase of the first assessment cycle for the Rehabilitation component.
  • 2002: The Trauma Services Advisory Group (Rehabilitation/Support for Social Participation component) took on responsibility for the second phase of the mandate related to the first assessment cycle, which involved creating consortiums of neurotrauma facilities providing care to individuals living with a moderate-to-severe TBI.
  • 2004: The Trauma Services Advisory Groups took on the assessment mandate to designate two expert care centres for severe burn victims.
  • In the spring of 2004, the MSSS commissioned the Trauma Services Advisory Group to design and engineer assessment functions for the entire Trauma Care Continuum and to implement a continuous quality improvement program covering every component. Since the trauma centre network had already been targeted in the past, the new mandate covered the prehospital and posthospital phases.
  • 2005: An advisory committee was formed to determine and structure the services to be provided to individuals living with a mild trauma brain injury (TBI), according to their needs. The 2005–2010 ministerial guidelines for mild TBI had been released in early 2006, and steps got under way to assess regional service approaches to assisting this client group.
  • 2006: The Trauma Services Advisory Group (Rehabilitation/Support for Social Participation component) accepted a mandate for a second assessment cycle, with the objective of consolidating the consortiums of facilities providing services to individuals with a moderate-to-severe TBI.
  • In spring 2004, the MSSS had commissioned the SAAQ to design and engineer assessment functions for the entire Trauma Services Continuum and to implement a continuous quality improvement program covering every component. Since the trauma centre network had already been targeted in the past, the new mandate covered the prehospital and posthospital phases.
  • In 2008, the team responsible for Trauma Services Continuum Assessment Functions (TSCAF) joined AETMIS, helping consolidate its assessment expertise.

In June 2010, the Act respecting the Institut national d’excellence en santé et en services sociaux (INESSS) was assented to by the National Assembly of Québec. The Act resulted in the merger between the Conseil du médicament and the Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS). As a result, AETMIS’s Trauma Services Continuum Assessment Team is now managed by INESSS.

Results obtained

A follow-up study on the effects of implementing the TSC revealed lower mortality rates among victims with serious injuries, which fell from 51.8% in 1992 to 8.6% in 2002. These data come from the trauma Registry, which was created in partnership with the MSSS, SAAQ and McGill University, as a means of monitoring the progress of the TSC.

This unique Trauma Services Continuum model emerged as the result of a partnership with the health and social services network. It is the product of several years of hard work on the part of all partners of the network to ensure that waiting times for access to quality care are as short as possible, regardless of Québec geography and demographics.

Recognized quality

In a 2004–2005 report, the Auditor General of Québec (AGQ) concluded that the Trauma Services Continuum for people with a moderate-to-acute TBI satisfied most of the AGQ’s assessment criteria for physical health and specialized rehabilitation services provided in the Capitale-Nationale and Bas-Saint-Laurent regions:

  • leadership;
  • clear allocation of responsibilities;
  • mechanisms for concerted action, coordination and follow-up;
  • stakeholder commitment;
  • accessibility and continuity in service delivery;
  • implementation of bidirectional communication and bridging mechanisms  between stakeholders;
  • availability of clinical information and a fast, unimpeded flow of information;
  • sharing of protocols based on known practices or evidence;
  • continuous quality improvement system.

In 2006, the Institut de l’administration publique du Québec honoured the TSC team with an award of excellence in the public service category for the quality of its work.

The Trauma Services Continuum (TSC) was born of a partnership between the Ministère de la Santé et des Services sociaux (MSSS) and the Société de l’assurance automobile du Québec (SAAQ), which began in 1992. The scope, effectiveness and efficiency of the practices put in place and the results obtained distinguish the TSC from the organizations and approaches found elsewhere in Canada and abroad. There is no doubt that Québec trauma victims benefit from one of the best systems, and it is TSC’s excellent work and its substantial positive impact that have won this recognition.

One of the Continuum’s strengths is its continuous quality improvement system, which serves to prevent, detect and rectify situations that could jeopardize the quality of care. It is to that end that INESSS trauma team offers its partners the CST Web site, which is a computerized assessment tool that help improve the effectiveness of the current network.

Congratulations to every person and organization that helped make TSC a model of excellence for its peers in the Québec public administration!!

Pre-collision Collision Post-collision

Prehospital

Hospital

Readaptation