Gyedu Adam, Issaka Adamu, Donkor Peter, Mock Charles
Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Afr J Emerg Med. 2024 Jun;14(2):122-127. doi: 10.1016/j.afjem.2024.05.001. Epub 2024 May 16.
Frequent reassessment of injured patients is an important component of trauma and emergency care. How frequently such reassessment is done in African hospitals has been minimally addressed. We sought to address this gap, as well as to assess the effectiveness of a standardized trauma intake form (TIF) to improve assessment and reassessment rates.
We undertook a stepped-wedge cluster randomized trial with research assistants observing trauma care before and after introducing the TIF at emergency units of eight non-tertiary Ghanaian hospitals for 17.5 months. Differences in seven key performance indicators (KPIs) of assessment and reassessment were evaluated using generalized linear mixed regression. KPIs included: respiratory rate, heart rate, blood pressure, level of consciousness, mobility, temperature, and oxygen saturation.
Management of 4077 patients was observed: 2067 before TIF initiation and 2010 after. In the before period, completion of KPIs of initial assessment ranged from 55% (oxygen saturation) to 88% (level of consciousness). KPIs for reassessment for patients still in the EU after 30 min ( = 1945, in before period) were much lower than for initial assessment, ranging from 10% (respiratory rate and oxygen saturation) to 13% (level of consciousness). The TIF did not significantly improve performance of any KPI of assessment or reassessment. Similar patterns pertained for the subgroup of seriously injured patients (Injury Severity Score ≥9).
At non-tertiary hospitals in Ghana, performance of KPIs of initial assessment were mostly adequate, but with room for improvement. Performance of KPIs for reassessment were very low, even for seriously injured patients. The intervention (trauma intake form) did not impact reassessment rates, despite previously having been shown to impact many other KPIs of trauma care. Potential avenues to pursue to improve reassessment rates include other quality improvement efforts and increased emphasis on reassessment in training courses.
对受伤患者进行频繁的重新评估是创伤和急诊护理的重要组成部分。在非洲医院进行这种重新评估的频率很少有人提及。我们试图填补这一空白，并评估标准化创伤入院表格（TIF）对提高评估和重新评估率的有效性。
我们进行了一项阶梯式楔形整群随机试验，研究助理在加纳八家非三级医院的急诊科引入TIF之前和之后的17.5个月内观察创伤护理情况。使用广义线性混合回归评估评估和重新评估的七个关键绩效指标（KPI）的差异。KPI包括：呼吸频率、心率、血压、意识水平、活动能力、体温和血氧饱和度。
观察了4077例患者的管理情况：TIF启用前2067例，启用后2010例。在前期，初始评估KPI的完成率从55%（血氧饱和度）到88%（意识水平）不等。30分钟后仍在急诊室的患者（前期为1945例）重新评估的KPI远低于初始评估，从10%（呼吸频率和血氧饱和度）到13%（意识水平）不等。TIF并未显著提高评估或重新评估的任何KPI的表现。重伤患者亚组（损伤严重度评分≥9）也有类似模式。
在加纳的非三级医院，初始评估KPI的表现大多足够，但仍有改进空间。重新评估KPI的表现非常低，即使是重伤患者。尽管之前已证明该干预措施（创伤入院表格）会影响创伤护理的许多其他KPI，但并未影响重新评估率。提高重新评估率的潜在途径包括其他质量改进措施以及在培训课程中更加强调重新评估。
