Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata: Effect on Care Process Measures

Angela Lashoher¹, Eric B Schneider^{2

3}, Catherine Juillard⁴, Kent Stevens⁵, Elizabeth Colantuoni⁶, William R Berry⁷, Christina Bloem⁸, Witaya Chadbunchachai⁹, Satish Dharap¹⁰, Sydney M Dy¹¹, Gerald Dziekan¹², Russell L Gruen¹³, Jaymie A Henry¹⁴, Christina Huwer¹⁵, Manjul Joshipura¹⁶, Edward Kelley¹⁷, Etienne Krug¹⁸, Vineet Kumar¹⁹, Patrick Kyamanywa²⁰, Alain Chichom Mefire²¹, Marcos Musafir²², Avery B Nathens²³, Edouard Ngendahayo²⁴, Thai Son Nguyen²⁵, Nobhojit Roy²⁶, Peter J Pronovost²⁷, Irum Qumar Khan²⁸, Junaid Abdul Razzak^{29

30}, Andrés M Rubiano³¹, James A Turner³², Mathew Varghese³³, Rimma Zakirova³⁴, Charles Mock³⁵

Affiliations

¹ , 14 Chemin de Contamine, 01420, Chanay, France.
² Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA. eschnei1@jhmi.edu.
³ Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD, USA. eschnei1@jhmi.edu.
⁴ Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Ave, 3A, San Francisco, CA, 94110, USA.
⁵ The Johns Hopkins School of Medicine, 1800 Orleans Street, Suite 6107E, Baltimore, MD, 21287, USA.
⁶ Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
⁷ Department of Health Policy and Management, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA.
⁸ Department of Emergency Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1228, Brooklyn, NY, 11203, USA.
⁹ WHO Collaborating Center for Injury Prevention and Safety Promotion, Khon Kaen Hospital, Khon Kaen, 40000, Thailand.
¹⁰ Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India.
¹¹ Johns Hopkins Bloomberg School of Public Health, Rm 609, 624 N Broadway, Baltimore, MD, 21205, USA.
¹² World Self-Medication Industry, Rue de Cossonay 5, Case Postale 124, 1023, Crissier, Switzerland.
¹³ Lee Kong Chian School of Medicine, Nanyang Technological University, Research Techno Plaza, #02-07, 50 Nanyang Drive, Singapore, 637553, Singapore.
¹⁴ Department of Surgery, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
¹⁵ Clinic for Trauma Surgery and Orthopedics, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
¹⁶ Academy of Traumatology, 504, Sangita Complex, Parimal Garden, Ahmadabad, 380015, India.
¹⁷ Service Delivery and Safety Department, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
¹⁸ Department for the Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
¹⁹ Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, College Building, First Floor, Sion, Mumbai, 400022, India.
²⁰ School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Nyarugenge Campus, P.O. Box. 3286, Kigali, Rwanda.
²¹ Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, P.O. Box 25526, Yaounde, Cameroon.
²² Federal University of Rio de Janeiro, Rua Voluntarios da Patria, 445 SL 201, Botafogo, Rio de Janeiro, CEP: 22270-005, Brazil.
²³ Department of Surgery, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D5 74, Toronto, Ontario, M4N 3M5, Canada.
²⁴ University Teaching Hospital of Kigali, P.O. Box 2534, Kigali, Rwanda.
²⁵ Duc Giang General Hospital, 54 Truong Lam, Long Bien, Hanoi, Vietnam.
²⁶ Department of Surgery, BARC hospital (Govt of India), HBNI University, Anushaktinagar, Mumbai, 400094, India.
²⁷ Johns Hopkins Medicine, 600 N Wolfe Street, CMSC 131, Baltimore, MD, 21287, USA.
²⁸ Department of Emergency Medicine, Aga Khan University, 1st floor, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
²⁹ Johns Hopkins University School of Medicine, 5801 Smith Ave, Ste 220, Baltimore, MD, 21219, USA.
³⁰ Aga Khan University, Karachi, Pakistan.
³¹ MEDITECH Foundation, Neiva University Hospital, Calle 5#11-19, Huila, Neiva, Colombia.
³² Department of Paedeatric Orthopedics, Sick Kids Hospital, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
³³ Department of Orthopaedics, St Stephen's Hospital, Tis Hazari, Delhi, 110054, India.
³⁴ St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
³⁵ Department of Surgery, Harborview Medical Center, HIPRC, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA.

PMID: 27800590
DOI: 10.1007/s00268-016-3759-8

Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata: Effect on Care Process Measures

Angela Lashoher et al. World J Surg. 2017 Apr.

. 2017 Apr;41(4):954-962.

doi: 10.1007/s00268-016-3759-8.

Authors

Affiliations

¹ , 14 Chemin de Contamine, 01420, Chanay, France.
² Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Suite 4-020, Boston, MA, 02120, USA. eschnei1@jhmi.edu.
³ Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins School of Medicine, Baltimore, MD, USA. eschnei1@jhmi.edu.
⁴ Department of Surgery, Center for Global Surgical Studies, University of California, San Francisco, 1001 Potrero Ave, 3A, San Francisco, CA, 94110, USA.
⁵ The Johns Hopkins School of Medicine, 1800 Orleans Street, Suite 6107E, Baltimore, MD, 21287, USA.
⁶ Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, Baltimore, MD, 21205, USA.
⁷ Department of Health Policy and Management, Harvard School of Public Health, 401 Park Drive, Boston, MA, 02215, USA.
⁸ Department of Emergency Medicine, SUNY Downstate Medical Center, 450 Clarkson Ave, Box 1228, Brooklyn, NY, 11203, USA.
⁹ WHO Collaborating Center for Injury Prevention and Safety Promotion, Khon Kaen Hospital, Khon Kaen, 40000, Thailand.
¹⁰ Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, 400022, India.
¹¹ Johns Hopkins Bloomberg School of Public Health, Rm 609, 624 N Broadway, Baltimore, MD, 21205, USA.
¹² World Self-Medication Industry, Rue de Cossonay 5, Case Postale 124, 1023, Crissier, Switzerland.
¹³ Lee Kong Chian School of Medicine, Nanyang Technological University, Research Techno Plaza, #02-07, 50 Nanyang Drive, Singapore, 637553, Singapore.
¹⁴ Department of Surgery, The University of Chicago, 5841 S Maryland Ave, Chicago, IL, 60637, USA.
¹⁵ Clinic for Trauma Surgery and Orthopedics, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
¹⁶ Academy of Traumatology, 504, Sangita Complex, Parimal Garden, Ahmadabad, 380015, India.
¹⁷ Service Delivery and Safety Department, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
¹⁸ Department for the Management of NCDs, Disability, Violence and Injury Prevention, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland.
¹⁹ Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, College Building, First Floor, Sion, Mumbai, 400022, India.
²⁰ School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Nyarugenge Campus, P.O. Box. 3286, Kigali, Rwanda.
²¹ Faculty of Health Sciences, University of Buea and Regional Hospital Limbe, P.O. Box 25526, Yaounde, Cameroon.
²² Federal University of Rio de Janeiro, Rua Voluntarios da Patria, 445 SL 201, Botafogo, Rio de Janeiro, CEP: 22270-005, Brazil.
²³ Department of Surgery, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D5 74, Toronto, Ontario, M4N 3M5, Canada.
²⁴ University Teaching Hospital of Kigali, P.O. Box 2534, Kigali, Rwanda.
²⁵ Duc Giang General Hospital, 54 Truong Lam, Long Bien, Hanoi, Vietnam.
²⁶ Department of Surgery, BARC hospital (Govt of India), HBNI University, Anushaktinagar, Mumbai, 400094, India.
²⁷ Johns Hopkins Medicine, 600 N Wolfe Street, CMSC 131, Baltimore, MD, 21287, USA.
²⁸ Department of Emergency Medicine, Aga Khan University, 1st floor, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
²⁹ Johns Hopkins University School of Medicine, 5801 Smith Ave, Ste 220, Baltimore, MD, 21219, USA.
³⁰ Aga Khan University, Karachi, Pakistan.
³¹ MEDITECH Foundation, Neiva University Hospital, Calle 5#11-19, Huila, Neiva, Colombia.
³² Department of Paedeatric Orthopedics, Sick Kids Hospital, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
³³ Department of Orthopaedics, St Stephen's Hospital, Tis Hazari, Delhi, 110054, India.
³⁴ St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
³⁵ Department of Surgery, Harborview Medical Center, HIPRC, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA.

PMID: 27800590
DOI: 10.1007/s00268-016-3759-8

Abstract

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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References

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Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata: Effect on Care Process Measures

Affiliations

Implementation of the World Health Organization Trauma Care Checklist Program in 11 Centers Across Multiple Economic Strata: Effect on Care Process Measures

Authors

Affiliations

Abstract

References

MeSH terms

LinkOut - more resources

Full Text Sources

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Medical