Nishimwe Aurore, Davies Justine, Byiringiro Jean Claude, Bekele Abebe, D'Ambruoso Lucia, Ignatowicz Agnieszka, Alayande Barnabas Tobi, D'Arc Nyinawankusi Jeanne, Uwitonze Jean Marie, Sindikubwabo Jean Nepomuscene, Bagahirwa Irene, Inkotanyi Collins, Jayaraman Sudha, Belli Antonio, Rickard Rob, Nuhu Assuman, Sheferaw Ephrem Daniel, Quiin Laura, Rukundo Gilbert, Muhire Philbert, Munyura Oda, Hagenimana Fabien, Hagumimana Didier
University of Birmingham.
University of Global Health Equity.
Res Sq. 2024 Dec 24:rs.3.rs-5640378. doi: 10.21203/rs.3.rs-5640378/v1.
Delays in getting injured patients to hospital in a timely manner can increase avoidable death and disability. Like many low- or middle-income countries (LMICs), Rwanda experiences delays related to lack of efficient prehospital communication and formal guidelines to triage patients for hospital care. This paper describes the protocol to develop, roll out, and evaluate the effectiveness of a Destination Decision Support Algorithm (DDSA) integrated in an electronic communication platform, '912Rwanda'. The DDSA will facilitate the linkage of patients to health facilities able to treat their condition(s). Work will be conducted in three phases: i. development, ii. training and roll-out, and iii. evaluation.
Work will be conducted in the pre-hospital emergency service "SAMU - Service d'Aide Medicale Urgente" and health facilities in Kigali City and Musanze District, which serve predominately urban and rural populations, respectively. We will develop interfaces to capture facility and patient-relevant data, which feed into a guideline-based electronic DDSA to match patients to hospitals. We will assess existing trauma care processes using qualitative and quantitative methodologies. This will be followed by a series of consensus workshops to develop at-scene triage guidelines and agree variables to capture in the interfaces. The DDSA will be developed based on outputs from these workshops and tested against historical ambulance data and expert opinion until acceptable thresholds of performance are passed. User interfaces will be developed and tested using human computer interface design principles.
The combined collaborative approach of bringing together experts and software developers, and with deep engagement of Rwandan stakeholders, including leadership of Rwanda Ministry of health through its technical arm, the Rwanda Biomedical Center, should lead to an ambulance communication system which is utilized, sustained, and effective.
受伤患者未能及时送往医院会增加可避免的死亡和残疾风险。与许多低收入或中等收入国家（LMICs）一样，卢旺达也存在因缺乏高效的院前沟通和将患者分诊至医院治疗的正式指南而导致的延误情况。本文描述了开发、推广并评估集成在电子通信平台“912卢旺达”中的目的地决策支持算法（DDSA）有效性的方案。DDSA将促进患者与能够治疗其病情的医疗机构之间的联系。工作将分三个阶段进行：一、开发；二、培训与推广；三、评估。
工作将在院前急救服务机构“紧急医疗救助服务（SAMU）”以及基加利市和穆桑泽区的医疗机构开展，这些机构分别主要服务城市和农村人口。我们将开发接口以获取与医疗机构和患者相关的数据，这些数据将输入基于指南的电子DDSA，以便为患者匹配医院。我们将使用定性和定量方法评估现有的创伤护理流程。随后将举办一系列共识研讨会，以制定现场分诊指南并商定接口中要采集的变量。DDSA将基于这些研讨会的成果进行开发，并根据历史救护车数据和专家意见进行测试，直至达到可接受的性能阈值。用户界面将根据人机界面设计原则进行开发和测试。
将专家和软件开发人员聚集在一起，并让卢旺达利益相关者深度参与，包括卢旺达卫生部通过其技术部门卢旺达生物医学中心发挥领导作用，这种联合协作的方法应能打造出一个得到使用、持续运行且有效的救护车通信系统。
