Laytin Adam D, Azazh Aklilu, Girma Biruk, Debebe Finot, Beza Lemlem, Seid Heyria, Landes Megan, Wytsma Julia, Reynolds Teri A
University of California San Francisco, Department of Surgery, Center for Global Surgical Studies, 1001 Potrero Ave, Building 1, Room 400, San Francisco, CA 94110, USA.
Perelman School of Medicine at the University of Pennsylvania, Division of Traumatology, Surgical Critical Care and Emergency Surgery, 51 N. 39th St, MOB 1, Suite 120, Philadelphia, PA 19104, USA.
Afr J Emerg Med. 2019;9(Suppl):S28-S31. doi: 10.1016/j.afjem.2019.01.009. Epub 2019 Feb 4.
The African Federation for Emergency Medicine Trauma Data Project (AFEM-TDP) has created a protocol for trauma data collection in resource-limited settings using a clinical chart with embedded standardized data points that facilitates a systematic approach to injured patients. We performed a process evaluation of the protocol's implementation at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia to provide insights for adapting the protocol to our setting.
During the pilot implementation period, the quality of collected data was assessed. Structured key informant interviews about participant experiences and perceptions of the protocol implementation were then conducted. Interviews were analysed using a SWOT model.
During pilot data collection, the overall capture rate was 21%. Variables collected with high frequency included demographics, vital signs and ED diagnosis, while mechanism of injury and ED disposition were often missed. Key informant interviews identified Strengths, Weaknesses, Opportunities and Threats to the protocol. Strengths included improved patient care, enhanced training for junior providers and facilitated data collection. Weaknesses included inadequate supervision and challenges relating to the physical size of the form, which resulted in missing data. Opportunities included retrospective research and quality improvement work. Threats included perceived lack of a local champion, poor buy-in from other hospital departments and need for ongoing financial support.
A mixed methods process evaluation is an invaluable tool when implementing novel data collection protocols, especially in resource-limited settings. We determined early successes and challenges of the implementation of the AFEM-TDP protocol and generated strategies to adapt the protocol to better suit our setting. Lessons from this process evaluation may be informative for other researchers designing and implementing similar data collection protocols.
非洲急诊医学创伤数据项目联盟（AFEM-TDP）制定了一项在资源有限环境中收集创伤数据的方案，该方案使用嵌入标准化数据点的临床图表，有助于以系统方法处理受伤患者。我们在埃塞俄比亚亚的斯亚贝巴的提古安贝萨专科医院对该方案的实施进行了过程评估，以便为使该方案适用于我们的环境提供见解。
在试点实施期间，评估所收集数据的质量。随后对参与者关于该方案实施的经验和看法进行了结构化关键信息访谈。使用SWOT模型对访谈进行分析。
在试点数据收集期间，总体捕获率为21%。高频收集的变量包括人口统计学、生命体征和急诊科诊断，而受伤机制和急诊科处置情况常常缺失。关键信息访谈确定了该方案的优势、劣势、机会和威胁。优势包括改善患者护理、加强对初级医疗人员的培训以及便于数据收集。劣势包括监督不足以及与表格物理尺寸有关的挑战，这导致数据缺失。机会包括回顾性研究和质量改进工作。威胁包括感觉缺乏当地支持者、其他医院科室参与度低以及需要持续的资金支持。
在实施新的数据收集方案时，尤其是在资源有限的环境中，混合方法过程评估是一种非常宝贵的工具。我们确定了AFEM-TDP方案实施的早期成功和挑战，并制定了使该方案更好地适用于我们环境的策略。这一过程评估的经验教训可能对其他设计和实施类似数据收集方案的研究人员有参考价值。
