BACKGROUND: Trauma registries have been developed to describe the pattern of trauma and trauma workload, provide data for research, and to demonstrate changes in patient outcomes. Quality improvement using trauma registries at a system-wide level has been difficult to achieve. In Victoria, Australia, a statewide trauma system and trauma registry has been established to monitor and feedback the process of management and outcomes of major trauma patients across all healthcare providers. METHODS: The development and implementation of the Victorian State Trauma Registry (VSTR), including its role as a quality monitoring tool and results from the first 2 years of operation, are provided. RESULTS: More than 80% of major trauma patients are being managed at major trauma services and standardized death rates are comparable with international standards. Quality indicators identify some areas for improvement. CONCLUSION: VSTR data indicate that the statewide trauma system is working well and provides a method for ongoing monitoring and trauma care feedback.