Chiu‑Feng Wua, Valeria Chiub,c, Yu‑Chen Niena, Kuo‑Feng Huangc,d, Tin‑Chou Lid, Hsien‑Ta Hsuc,d*
aDepartment of Nursing, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, bDepartment of Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan, cSchool of Medicine, Tzu Chi University, Hualien, Taiwan, dDivision of Neurosurgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
Open Access funded by Buddhist Compassion Relief Tzu Chi Foundation
Abstract
Objectives: This study assesses the clinical and operational impact of implementing a quality certification program on the care of traumatic brain injury (TBI) patients at a medical center. By evaluating key performance metrics before and after program implementation, this study aims to determine the program’s effectiveness in enhancing patient outcomes. Materials and Methods: The study retrospectively analyzed 1197 cases, with 827 cases precertification (January 2019–June 2023) and 370 cases postcertification (July 2023– June 2024). Key metrics included Glasgow Coma Scale (GCS) scores, modified Rankin Scale (mRS) scores, Barthel Index (BI) scores, compliance with clinical protocols, hospital length of stay (LOS), healthcare costs, readmission rates, and patient satisfaction. Statistical significance was determined at P < 0.05. Results: The implementation of the quality certification program significantly improved compliance with key protocols. GCS assessment compliance increased from 79.61% to 100%, and timely computed tomography imaging improved from 94.17% to 96.64%. Functional recovery also improved, with mean mRS scores decreasing from 3.63 to 2.79, and mean BI scores increasing from 27.2 to 59.9. Hospital LOS decreased from 10.94 to 9.00 days (P = 0.027). Thirty‑day unplanned readmission rates dropped from 5.88% to 3.54%, and patient satisfaction scores improved from 87 to 89, including increases in physician care (+5.84 points) and respect for autonomy (+4.80 points). Healthcare costs decreased marginally from New Taiwan Dollar (NTD) 106,530 to NTD 86,182, though this reduction was not statistically significant (P = 0.23). Conclusion: The quality certification program fostered multidisciplinary collaboration and standardized care, resulting in improved clinical outcomes, greater functional recovery, and enhanced patient satisfaction. These findings underscore the program’s value in modern healthcare settings and its potential to optimize TBI care.
Keywords: Barthel index, Glasgow Coma Scale, Modified Rankin scale, Quality certification program, Traumatic brain injury
