Developing and integrating a destination decision support algorithm into an innovative electronic communication platform to improve injury care service coordination in Rwanda: the Rwanda912 study protocol

Abstract

Introduction: Delays in getting injured patients to the hospital in a timely manner can increase avoidable death and disability. Like many low-income or middle-income countries, Rwanda experiences delays related to a lack of efficient prehospital communication and formal guidelines to triage patients for hospital care. This study describes the protocol to develop, roll-out and evaluate the effectiveness of a destination decision support algorithm (DDSA) integrated in an electronic communication platform, '912Rwanda'. The DDSA will facilitate the linkage of patients to health facilities able to treat their condition(s).

Methods and analysis: Work will be conducted in the prehospital emergency service 'Service d'Aide Médicale Urgente' and health facilities in Kigali city and Musanze district, which serve predominantly urban and rural populations, respectively. We will develop interfaces to capture facility and patient-relevant data, which feed into a guideline-based electronic DDSA to match patients to hospitals. We will assess existing trauma care processes using qualitative and quantitative methodologies. This will be followed by a series of consensus workshops to develop at-scene triage guidelines and agree on variables to capture in the interfaces. The DDSA will be developed based on outputs from these workshops and will be tested against historical ambulance data and expert opinion until acceptable thresholds of performance are achieved. User interfaces will be developed and tested using human-computer interface design principles.

Discussion: The combined collaborative approach of bringing together experts and software developers, and with deep engagement of Rwandan stakeholders, including leadership of Rwanda Ministry of Health through its technical arm, Rwanda Biomedical Center, should lead to an ambulance communication system which is used, sustained and effective.

Ethics and dissemination: The project was approved by the Rwanda National Research Ethics Committee. Annual reports will be disseminated to relevant stakeholders, followed by the public. Publications will be open access as per the funding policy.

Trial registration number: ISRCTN97674565. Registered on 29 July 2024. https://doi.org/10.1186/ISRCTN97674565.

Keywords: ACCIDENT & EMERGENCY MEDICINE; Clinical Decision-Making; Health informatics; Information technology; eHealth.

Figure 1. Inefficient communication (red arrows denote multiple mobile telephone calls) among the dispatch centre, ambulance crews and health facilities, resulting in avoidable prehospital delays. Note: Each red arrow is a phone call.

Figure 2. The destination decision support algorithm (DDSA) concept and solution. Note: Each red arrow is a phone call and each blue arrow is mHealth communication.

Figure 3. Summary of study flow. DDSA, destination decision support algorithm. RE-AIM, Reach, Effectiveness, Adoption, Implementation, and Maintenance; QuEST, Qualitative Evaluation for Systematic Translation.

Figure 4. Objective 1: stages and analysis. DDSA, destination decision support algorithm.

Figure 5. Objective 2: stages and analysis. OSCE, objective structured clinical examination. FGD, Focus group discussion.