Wild Hannah, Mock Charles, Lim Andrew
Stanford University School of Medicine, Stanford, CA, USA; Department of Surgery, University of Washington, Seattle, WA, USA.
Department of Surgery, University of Washington, Seattle, WA, USA.
Int J Surg. 2020 Nov;83:15-23. doi: 10.1016/j.ijsu.2020.08.050. Epub 2020 Sep 12.
The World Health Organization (WHO) Trauma Care Checklist (TCC) has been documented to improve care of the injured. Factors that promote TCC use have not been well evaluated. We sought to identify barriers and facilitators affecting TCC use.
A qualitative study was conducted by interviewing regional leaders and health care providers at hospitals where the initial WHO TCC pilot study had been conducted in 2010-2012. Study participants included trauma system directors, surgeons, emergency medicine physicians, nurses, and house staff in nine countries. Interview transcripts were thematically analyzed in Dedoose software using deductive and inductive coding strategies incorporating elements of grounded theory.
Eighteen participants representing nine of the 11 original pilot sites were interviewed, including 14 doctors and four nurses. Participants represented departments of trauma/trauma surgery (n = 13) and emergency medicine (n = 5). Three sites continued to use the TCC in a nearly original form; three sites used a significantly modified version; and the remaining three sites no longer used it. The most commonly identified facilitator of TCC use was endorsement at both the front-line provider and institutional/leadership level (n = 7). Personnel-related issues and resistance from individual providers were the most commonly identified barriers (n = 10).
Presence of an institutional champion, context-specific adaptation, and integration of the TCC with existing care and documentation practices contribute to successful utilization. Personnel constraints such as revolving trainees and resistance from individual providers hinder utilization. To improve TCC uptake, participants also recommended that TCC be more closely integrated with courses such as Advanced Trauma Life Support.
世界卫生组织（WHO）创伤护理检查表（TCC）已被证明可改善对伤者的护理。促进TCC使用的因素尚未得到充分评估。我们试图确定影响TCC使用的障碍和促进因素。
通过采访2010 - 2012年进行WHO首次TCC试点研究的医院的地区负责人和医疗服务提供者进行了一项定性研究。研究参与者包括九个国家的创伤系统主任、外科医生、急诊医学医生、护士和住院医生。使用Dedoose软件，采用结合扎根理论要素的演绎和归纳编码策略，对访谈记录进行了主题分析。
对代表11个原始试点地点中9个地点的18名参与者进行了访谈，包括14名医生和4名护士。参与者来自创伤/创伤外科（n = 13）和急诊医学（n = 5）科室。三个地点继续以近乎原始的形式使用TCC；三个地点使用了大幅修改的版本；其余三个地点不再使用。最常被确定的TCC使用促进因素是一线提供者和机构/领导层面的认可（n = 7）。与人员相关的问题和个别提供者的抵制是最常被确定的障碍（n = 10）。
机构支持者的存在、因地制宜的调整以及TCC与现有护理和记录实践的整合有助于成功使用。人员限制，如轮转实习生和个别提供者的抵制，阻碍了使用。为了提高TCC的采用率，参与者还建议将TCC与高级创伤生命支持等课程更紧密地整合。
