Northwestern University, Feinberg School of Medicine, Department of Surgery, Division of Trauma & Critical Care, Chicago, IL.
Northwestern University, Feinberg School of Medicine, Department of Surgery, Division of Trauma & Critical Care, Chicago, IL; New York Presbyterian Hospital, Columbia University Medical Center, Department of Surgery, New York, NY; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA.
Ann Glob Health. 2017 Mar-Apr;83(2):262-273. doi: 10.1016/j.aogh.2017.04.002. Epub 2017 May 24.
Scaling up surgical and trauma care in low- and middle-income countries could prevent nearly 2 million annual deaths. Various survey instruments exist to measure surgical and trauma capacity, including Personnel, Infrastructure, Procedures, Equipment, and Supplies (PIPES) and International Assessment of Capacity for Trauma (INTACT).
We sought to evaluate surgical and trauma capacity in the Bolivian department of Potosí using a combined PIPES and INTACT tool, with additional questions to further inform intervention targets.
In June and July 2014 a combined PIPES and INTACT survey was administered to 20 government facilities in Potosí with a minimum of 1 operating room: 2 third-level, 10 second-level, and 8 first-level facilities. A surgeon, head physician, director, or obstetrician-gynecologist completed the survey. Additional personnel responded to 4 short-answer questions. Survey items were divided into subsections, and PIPES and INTACT indices calculated. Medians were compared via Wilcoxon rank sum and Kruskal-Wallis tests.
Six of 20 facilities were located in the capital city and designated urban. Urban establishments had higher median PIPES (8.5 vs 6.7, P = .11) and INTACT (8.5 vs 6.9, P = .16) indices compared with rural. More than half of surgeons and anesthesiologists worked in urban hospitals. Urban facilities had higher median infrastructure and procedure scores compared with rural. Fifty-three individuals completed short-answer questions. Training was most desired in laparoscopic surgery and trauma management; less than half of establishments reported staff with trauma training.
Surgical and trauma capacity in Potosí was most limited in personnel, infrastructure, and procedures at rural facilities, with greater personnel deficiencies than previously reported. Interventions should focus on increasing the number of surgical and anesthesia personnel in rural areas, with a particular focus on the reported desire for trauma management training. Results have been made available to key stakeholders in Potosí to inform targeted quality improvement interventions.
在中低收入国家扩大外科和创伤护理可预防近 200 万人的年死亡人数。现已有各种调查工具来衡量外科和创伤能力，包括人员、基础设施、程序、设备和用品（PIPES）以及国际创伤能力评估（INTACT）。
我们试图使用综合 PIPES 和 INTACT 工具评估玻利维亚波托西省的外科和创伤能力，并增加了一些额外的问题，以进一步明确干预目标。
2014 年 6 月至 7 月，对波托西的 20 家政府机构进行了综合 PIPES 和 INTACT 调查，这些机构至少有 1 间手术室：2 家 3 级、10 家 2 级和 8 家 1 级机构。由外科医生、主治医生、主任或妇产科医生完成调查。其他人员回答了 4 个简答题。调查项目分为小节，计算 PIPES 和 INTACT 指数。中位数采用 Wilcoxon 秩和检验和 Kruskal-Wallis 检验进行比较。
20 家机构中有 6 家位于首府和指定城市。与农村地区相比，城市机构的 PIPES（8.5 比 6.7，P=0.11）和 INTACT（8.5 比 6.9，P=0.16）指数更高。一半以上的外科医生和麻醉师在城市医院工作。与农村地区相比，城市机构的基础设施和程序得分更高。53 人回答了简答题。腹腔镜手术和创伤管理培训需求最大；不到一半的机构报告称有受过创伤培训的工作人员。
波托西的外科和创伤能力在农村地区的人员、基础设施和程序方面受到的限制最大，人员不足的情况比以前报告的更为严重。干预措施应侧重于增加农村地区的外科和麻醉人员数量，并特别关注报告中对创伤管理培训的需求。结果已提供给波托西的主要利益相关者，以告知有针对性的质量改进干预措施。
