Trauma system components and benchmarking activities in Quebec and the English National Health Service*
| Component/activity | Quebec | NHS |
|---|---|---|
| Trauma system component | ||
| Trauma centres | 10 MTCs (5 level I [3 adult centres and 2 pediatric centres], 5 level II, 21 level III, 28 level IV) | 27 MTCs, 154 trauma units |
| No. of MTCs per 100 000 population | 0.125 | 0.05 |
| No. of MTCs per 1000 km2 | 0.006 | 0.111 |
| Designation/accreditation | Institut national d’excellence en santé et services sociaux; mandatory | Strategic Health Authorities; mandatory |
| Prehospital triage | Uniform, validated tool (adapted from American College of Surgeons Committee on Trauma) | Varies across regions |
| Bypass to MTC | 60 min | 60 min |
| Highest level of prehospital care | Level II. Basic Life Support | Level IV. Advanced Life Support On-Scene, Physician Field Care |
| Prehospital intubation | None | Tracheal intubation Surgical airway Nontracheal intubation intervention: pharyngeal tube, supraglottic airway device, airway positioning |
| Prehospital transportation | Ground; fixed-wing aircraft | Ground; fixed-wing aircraft; helicopter |
| Trauma team leader | In 1 level I hospital | All MTCs |
| Benchmarking activities | ||
| Process indicators | 13 | Tranexamic acid, rapid sequence intubation, rehabilitation prescription |
| Risk-adjusted outcomes | Death, readmission, complications, hospital length of stay | Death |
| Feedback | Confidential audit and feedback reports | Publicly available reports, dashboards, best practice tariffs, alerts (2 SDs), alarms (3 SDs) |
| Accountability | Mandatory quality-improvement report; linked to accreditation | Pay-for-performance indicators |
| Frequency | Accreditation cycles (about 3 yr) | 4 mo (reports), 3 mo (dashboard) |
MTC = major trauma centre; NHS = English National Health Service; SD = standard deviation.
↵* Sources: The Trauma Audit & Research Network (https://www.tarn.ac.uk/) and the Trauma Care Continuum, Institut national d’excellence en santé et services sociaux (https://www.inesss. qc.ca/thematiques/sante/traumatologie/continuum-de-services-en-traumatologie-cst.html).