UNC Project, Lilongwe, Malawi.
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
World J Surg. 2017 Dec;41(12):3066-3073. doi: 10.1007/s00268-017-4121-5.
In resource-limited settings, identification of successful and sustainable task-shifting interventions is important for improving care.
To determine whether the training of lay people to take vital signs as trauma clerks is an effective and sustainable method to increase availability of vital signs in the initial evaluation of trauma patients.
We conducted a quasi-experimental study of patients presenting with traumatic injury pre- and post-intervention.
The study was conducted at Kamuzu Central Hospital, a tertiary care referral hospital, in Lilongwe, Malawi.
All adult (age ≥ 18 years) trauma patients presenting to emergency department over a six-month period from January to June prior to intervention (2011), immediately post-intervention (2012), 1 year post-intervention (2013) and 2 years post-intervention (2014).
Lay people were trained to take and record vital signs.
The number of patients with recorded vital signs pre- and post-intervention and sustainability of the intervention as determined by time-series analysis.
Availability of vital signs on initial evaluation of trauma patients increased significantly post-intervention. The percentage of patients with at least one vital sign recorded increased from 23.5 to 92.1%, and the percentage of patients with all vital signs recorded increased from 4.1 to 91.4%. Availability of Glasgow Coma Scale also increased from 40.3 to 88.6%. Increased documentation of vital signs continued at 1 year and 2 years post-intervention. However, the percentage of documented vital signs did decrease slightly after the US-trained medical student and surgeon who trained the trauma clerks were no longer available in country, except for Glasgow Coma Scale. Patients who died during emergency department evaluation were significantly less likely to have vital signs recorded.
The training of lay people to collect vital signs and Glasgow Coma Scale is an effective and sustainable method of task shifting in a resource-limited setting.
在资源有限的情况下，确定成功且可持续的任务转移干预措施对于改善医疗服务至关重要。
确定将非专业人员培训为创伤分诊员以测量生命体征是否是一种有效且可持续的方法，可增加创伤患者初始评估中生命体征的可用性。
我们对干预前后的创伤患者进行了准实验研究。
研究在马拉维利隆圭的三级转诊医院卡姆祖中央医院进行。
干预前（2011 年）、干预后即刻（2012 年）、干预后 1 年（2013 年）和干预后 2 年（2014 年）的 6 个月期间内，所有成年（年龄≥18 岁）创伤患者均纳入研究。
培训非专业人员测量和记录生命体征。
干预前后记录生命体征的患者数量以及通过时间序列分析确定干预的可持续性。
创伤患者初始评估时生命体征的可用性显著增加。记录至少一项生命体征的患者比例从 23.5%增加到 92.1%，记录所有生命体征的患者比例从 4.1%增加到 91.4%。格拉斯哥昏迷量表的可用性也从 40.3%增加到 88.6%。干预后 1 年和 2 年，生命体征的记录仍在增加。然而，在培训创伤分诊员的美国受训医学生和外科医生不再在该国后，记录的生命体征百分比略有下降，格拉斯哥昏迷量表除外。在急诊科评估期间死亡的患者记录生命体征的可能性明显较低。
在资源有限的情况下，培训非专业人员测量生命体征和格拉斯哥昏迷量表是任务转移的一种有效且可持续的方法。
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