Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
BMJ Open. 2023 Feb 17;13(2):e068219. doi: 10.1136/bmjopen-2022-068219.
Trauma is a leading cause of mortality and morbidity globally, disproportionately affecting low/middle-income countries (LMICs). Understanding the factors determining implementation success for in-hospital Trauma Quality Improvement Programs (TQIPs) is critical to reducing the global trauma burden. We synthesised topical literature to identify key facilitators and barriers to in-hospital TQIP implementation across country income levels.
Scoping review.
PubMed, Web of Science and Global Index Medicus databases were searched from June 2009 to January 2022.
Published literature involving any study design, written in English and evaluating any implemented in-hospital quality improvement programme in trauma populations worldwide. Literature that was non-English, unpublished and involved non-hospital TQIPs was excluded.
Two reviewers completed a three-stage screening process using Covidence, with any discrepancies resolved through a third reviewer. Content analysis using the Consolidated Framework for Implementation Research identified facilitator and barrier themes for in-hospital TQIP implementation.
Twenty-eight studies met the eligibility criteria from 3923 studies identified. The most discussed in-hospital TQIPs in included literature were trauma registries. Facilitators and barriers were similar across all country income levels. The main facilitator themes identified were the prioritisation of staff education and training, strengthening stakeholder dialogue and providing standardised best-practice guidelines. The key barrier theme identified in LMICs was poor data quality, while high-income countries (HICs) had reduced communication across professional hierarchies.
Stakeholder prioritisation of in-hospital TQIPs, along with increased knowledge and consensus of trauma care best practices, are essential efforts to reduce the global trauma burden. The primary focus of future studies on in-hospital TQIPs in LMICs should target improving registry data quality, while interventions in HICs should target strengthening communication channels between healthcare professionals.
创伤是全球导致死亡和发病的主要原因，对中低收入国家（LMICs）的影响尤为严重。了解决定院内创伤质量改进计划（TQIPs）实施成功的因素对于降低全球创伤负担至关重要。我们综合了专题文献，以确定不同国家收入水平下院内 TQIP 实施的关键促进因素和障碍。
范围审查。
从 2009 年 6 月到 2022 年 1 月，在 PubMed、Web of Science 和全球索引医学数据库中进行了搜索。
发表的文献涉及任何研究设计，用英文书写，并评估全球创伤人群中实施的任何院内质量改进计划。非英文、未发表和涉及非医院 TQIP 的文献被排除在外。
两名审查员使用 Covidence 完成了一个三阶段的筛选过程，任何分歧都通过第三名审查员解决。使用实施研究综合框架进行的内容分析确定了院内 TQIP 实施的促进因素和障碍主题。
从 3923 篇文章中确定了 28 篇符合入选标准的文章。文献中讨论最多的院内 TQIP 包括创伤登记处。促进因素和障碍在所有国家收入水平下都是相似的。确定的主要促进因素主题包括优先考虑员工教育和培训、加强利益相关者对话和提供标准化最佳实践指南。在 LMICs 中确定的关键障碍主题是数据质量差，而高收入国家（HICs）则减少了专业阶层之间的沟通。
利益相关者对院内 TQIP 的优先排序，以及增加对创伤护理最佳实践的了解和共识，是降低全球创伤负担的必要努力。未来在 LMICs 中进行院内 TQIP 研究的主要重点应针对提高登记处数据质量，而在 HICs 中的干预措施应针对加强医疗保健专业人员之间的沟通渠道。
