N. Wu1, T. C. Nana1, R. Dicker1, M. Carvalho1, O. Nwanna-Nzewunwa1, G. Motwani1, S. A. Christie1, A. Chichom Mefire1, C. Juillard1 1Center For Global Surgical Studies,University Of California, San Francisco,San Francisco, CA, USA
Introduction: Injuries are a leading cause of death and disability worldwide. Developing countries account for 90% of injury-related deaths globally. Trauma audit filters can facilitate trauma quality improvement initiatives and reduce the injury burden. Little is known about context-appropriate trauma audit filters for developing countries like Cameroon. This study aimed to (1) develop context-appropriate trauma audit filters for the setting of a regional referral hospital in Cameroon and (2) to assess the barriers and facilitators to their implementation.
Methods: Feasible audit filters were identified by a panel of Cameroonian surgeons using the Delphi technique. A Likert scale (1 to 5, with 5 as “Most Useful”) was used to rank the filters for utility in a regional referral hospital setting, analyzed using median and interquartile range. Semi-structured interviews were conducted with 16 healthcare providers from three hospital facilities to explore their perceptions of supervision and support they receive from hospital administration, availability of resources, their work environment, and potential concerns and impacts of trauma audit filters. Interviews were coded and thematically analyzed.
Results: Within a panel of seven surgeons, 18 out of 40 trauma audit filter variables met majority consensus criteria. Sixteen of these, comprising mostly of primary survey and basic resuscitation techniques, had a median score of ≥ 4. Filters meeting consensus include, but are not limited to: vitals obtained, breathing assessment made, and two large bore IVs established – within 15 minutes of arrival; patient with open fracture receives IV antimicrobials within one hour or arrival; patients with suspected spine injury are immobilized and given x-ray. The provider interviews revealed that the barriers to providing quality care were limited human and material resources and patients’ inability to pay. Regular staff training in trauma care and the belief that trauma audit filters would potentially streamline work practices and improve the quality of care were cited as promoters of successful implementation.
Conclusion: Primary survey and basic resuscitative techniques are key elements of context-appropriate audit filters in Cameroon. Such audit filters may not be costly or require complex infrastructure or equipment that exceed the site’s capabilities. Proper staff orientation and participation in the use of trauma audit filters as quality improvement tools are key to local buy-in and implementation success.