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Objectives <p>Data on the sustainability of trauma quality improvement (QI) initiatives has been limited, especially in low- and middle-income countries (LMICs). We sought to determine how use of a standardized trauma intake form (TIF) with built-in memory prompts varied over time and how this affected achievement of key performance indicators (KPIs) of trauma care in Ghana.</p> Methods <p>We conducted a randomized clinical trial at eight non-tertiary hospitals (2020–2021). After TIF initiation, percent TIF use and achievement of 16 KPIs were recorded by trained observers. TIF initiation involved engagement with and training for clinicians at each hospital. The study also utilized ongoing monitoring of TIF use with feedback to hospital staff when TIF use was low at a given hospital.</p> Results <p>We enrolled 2,010 injured patients over 14 months. TIF use increased steadily, from 80% (period 1, first 3.5 months), to 84% (period 2, next 3.5 months), to 89% (period 3, subsequent 3.5 months), to 100% (period 4, final 3.5 months) (<i>p</i> &lt; 0.001). Achievement of 12 of 16 KPIs increased significantly. For example, assessment for intraabdominal bleeding went from 84% complete (period 1), to 87% (period 2), to 91% (period 3), to 100% (period 4) (<i>p</i> &lt; 0.001). Fifteen KPIs were performed in over 90% of patients in period 4.</p> Conclusions <p>Sustainable implementation of trauma QI initiatives is feasible in LMICs. Optimal usage required time, with both TIF use and KPI achievement gradually rising over a year. Ongoing monitoring, with feedback and engagement with hospital staff are key to achieving these sustained increases.</p>

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Towards sustaining a trauma quality improvement initiative in Ghana: results of a clinical trial

  • 期刊论文

  • 发表日期：

    2025年12月18日

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  • Adam Gyedu,
  • Kwabena Awuku,
  • Isaac Asenso Brobbey-Kyei,
  • Peter Donkor,
  • Charles Mock

摘要

Objectives

Data on the sustainability of trauma quality improvement (QI) initiatives has been limited, especially in low- and middle-income countries (LMICs). We sought to determine how use of a standardized trauma intake form (TIF) with built-in memory prompts varied over time and how this affected achievement of key performance indicators (KPIs) of trauma care in Ghana.

Methods

We conducted a randomized clinical trial at eight non-tertiary hospitals (2020–2021). After TIF initiation, percent TIF use and achievement of 16 KPIs were recorded by trained observers. TIF initiation involved engagement with and training for clinicians at each hospital. The study also utilized ongoing monitoring of TIF use with feedback to hospital staff when TIF use was low at a given hospital.

Results

We enrolled 2,010 injured patients over 14 months. TIF use increased steadily, from 80% (period 1, first 3.5 months), to 84% (period 2, next 3.5 months), to 89% (period 3, subsequent 3.5 months), to 100% (period 4, final 3.5 months) (p < 0.001). Achievement of 12 of 16 KPIs increased significantly. For example, assessment for intraabdominal bleeding went from 84% complete (period 1), to 87% (period 2), to 91% (period 3), to 100% (period 4) (p < 0.001). Fifteen KPIs were performed in over 90% of patients in period 4.

Conclusions

Sustainable implementation of trauma QI initiatives is feasible in LMICs. Optimal usage required time, with both TIF use and KPI achievement gradually rising over a year. Ongoing monitoring, with feedback and engagement with hospital staff are key to achieving these sustained increases.