198EMF Improving Ugandan Trauma Data Capture and Documentation Quality Using A Novel World Health Organization Emergency Unit Trauma Form

Abstract

Injuries claim the lives of over 5 million people per year, which is 1.7 times the number of deaths from HIV/AIDS, tuberculosis, and malaria combined. Ninety per cent of global mortality from injury occurs in low- and middle-income countries (LMICs). Efforts to address this are hindered by a critical lack of data on injury from that setting. To this end, the WHO Emergency, Trauma and Acute Care program has developed the Emergency Unit Form: Trauma, a standardized chart that serves dual functions as clinical documentation and a data collection form. We studied the pilot implementation of this form in six Ugandan hospitals over a six-month period. We aimed to evaluate the utility of the form in improving data collection rates of key points from the Dataset for Injury (DSI). This was a mixed methods prospective observational cohort study evaluating the individual and aggregate data completion rates at six hospitals in central Uganda. The facilities are a mix of private hospitals and regional referral hospitals. We examined 32 data elements covering demographics, vitals, time metrics, details of injury, and ED outcome. Data were collected in binary fashion as either “recorded” or “missing,” and no clinical data were extracted. To assess utility we calculated pre- and post-implementation data element completion percentages, and to provide a broad picture of the implementation process we aggregated data completion rates by facility by taking the average of all 32 data elements. These were plotted over time in an interrupted time series analysis, with the break point being December 2018, the start of implementation. We also captured qualitative data on facilitators and barriers in Plan-Do-Study-Act format. A total of 1687 patient charts were analyzed, 948 from the pre-implementation phase and 739 from the implementation phase. Implementation cycles ran bi-monthly. For charts collected during the pre-implementation phase, we found an aggregate average DSI completion rate of 62.6% across all facilities, compared to 88.77% at mid-May 2019, after 10 implementation cycles. The strongest perceived facilitators were motivated local champions and administrative buy-in. The strongest perceived barriers were high staff turnover rate, poor form integration into existing workflow, and lack of equipment to capture quantitative data elements such as vital signs. Use of the WHO Standardized Trauma Form significantly improved capture of key elements of the Dataset for Injury. The form is an effective means of gathering data required to feed into trauma registries and implement robust quality improvement measures, which have been shown to reduce trauma mortality by up to 40% in the LMIC setting. Moving forward, we will stratify our sites by their success and perform positive and negative deviant analysis using structured qualitative interview methods to identify regionally generalizable facilitators and barriers. We hope these findings will result in an actionable implementation strategy to scale up use of the form to the remainder of Uganda.