Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata: Effect on Care Process Measures
Date
2017Author
Lashoher, Angela
Schneider, Eric B
Juillard, Catherine
Stevens, Kent
Colantuoni, Elizabeth
Berry, William R
Bloem, Christiana
Chadbunchachai, Witaya
Dharap, Satish
Dy, Sydney M
Dziekan, Gerald
Gruen, Russell L
Henry, Jaymie A
Huwer, Christiana
Joshipura, Manjul
Kelley, Edward
Krug, Etienne
Kumar, Vineet
Kyamanywa, Patrick
Mefire, Alain Chichom
Musafir, Marcos
Nathens, Avery B
Ngendahayo, Edouard
Nguyen, Thai Son
Roy, Nobhojit
Pronovost, Peter J
Khan, Irum Qumar
Razzak, Junaid Abdul
Rubiano, Andrés M
Turner, James A
Varghese, Mathew
Zakirova, Rimma
Mock, Charles
Metadata
Show full item recordAbstract
Background
Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would improve care for injured patients in low-, middle-, and high-income countries.
Methods
From 2010 to 2012, the impact of the World Health Organization (WHO) Trauma Care Checklist program was assessed in 11 hospitals using a stepped wedge pre- and post-intervention comparison with randomly assigned intervention start dates. Study sites represented nine countries with diverse economic and geographic contexts. Primary end points were adherence to process of care measures; secondary data on morbidity and mortality were also collected. Multilevel logistic regression models examined differences in measures pre- versus post-intervention, accounting for patient age, gender, injury severity, and center-specific variability.
Results
Data were collected on 1641 patients before and 1781 after program implementation. Patient age (mean 34 ± 18 vs. 34 ± 18), sex (21 vs. 22 % female), and the proportion of patients with injury severity scores (ISS) ≥ 25 (10 vs. 10 %) were similar before and after checklist implementation (p > 0.05). Improvement was found for 18 of 19 process measures, including greater odds of having abdominal examination (OR 3.26), chest auscultation (OR 2.68), and distal pulse examination (OR 2.33) (all p < 0.05). These changes were robust to several sensitivity analyses.
Conclusions
Implementation of the WHO Trauma Care Checklist was associated with substantial improvements in patient care process measures among a cohort of patients in diverse settings.
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- Journal Article [92]