A. E. Jaffe1, K. Vishwanathan2, S. Raithatha2, S. Nimbalkar2, H. P. Santry1 1University Of Massachusetts Medical School,Surgery,Worcester, MA, USA 2Charutar Arogya Mandal (CAM),Pramukhswami Medical College,Karamsad, GUJARAT, India
Introduction: Trauma accounts for >5 million deaths annually, with a large burden occurring in low- and middle-income countries (LMICs). In India, trauma is the most frequent cause of death for Indians <40 years, and 13-18% of all deaths are due to trauma. Trauma registries are an integral part of advanced trauma systems and have been shown to help reduce mortality in developed countries. Such registries are increasingly being implemented in LMICs. We conducted interviews with local stakeholders to identify barriers to registry implementation at Charutar Arogya Mandal (CAM) medical complex in Karamsad, Gujarat, India.
Methods: We conducted a 3-month pilot trauma registry to assess feasibility of a permanent registry for continuous trauma quality improvement at CAM where approximately 40% of emergency room patients are victims of trauma. The pilot consisted of a hardcopy registry form created in conjunction with key stakeholders at CAM. The form gathered basic demographic information, mechanism of injury, physiologic parameters, a brief description of injuries, outcome from emergency department and 2 week outcome for those admitted. Trauma Counselors (social workers) posted in the emergency department were responsible for filling out the forms with the assistance of Casualty Medical Officers (CMOs), surgical residents, and emergency room nurses. Following the pilot phase we conducted 16 interviews with staff (5 CMOs, 3 surgery and orthopedic surgery residents, 4 trauma counselors, and 4 nurses) who were directly or indirectly involved with the pilot registry to gather qualitative data on challenges, barriers, and success to implementation. Interviews were conducted in English, audio recorded and transcribed for review. Inductive analysis was used to identify themes representing barriers to registry implementation.
Results: Only 19% of people interviewed had previous knowledge of a trauma registry prior to the pilot. All respondents saw benefits to having a trauma registry at the hospital and were willing to help contribute to a registry. 50% of respondents encountered some barrier to filling out the registry form, with the most commonly mentioned barrier being ‘high patient volume.’ ‘Role in patient care’ was also identified by 50% as a barrier with trauma counselors being less suited for data collection compared to CMOs and residents. 100% thought that incorporating the form into the official medical record and replacing existing paperwork would provide the greatest benefit and reduce ‘duplication of effort.’
Conclusion: Trauma registries are a centerpiece of sophisticated trauma systems. However, implementation of trauma registries in LMICs must take into account barriers that may be structure, process, financial, or personnel related. Interviews with staff involved in the pilot phase of trauma registry can provide important qualitative data for successful planning of the next steps for implementation.