Utilization of a Trauma Quality Improvement Tool in a Clinical Trial: Effects When Tool Not Used.

Abstract

Introduction: A standardized trauma intake form (TIF) with built-in memory prompts was previously shown to increase achievement of key performance indicators (KPIs) of trauma care. We sought to understand what differentiated patients who did and did not have the TIF used and how this affected care. We also sought to assess whether TIF introduction resulted in hospital-wide improvements in care, even in patients for whom the TIF was not used.

Methods: We used data from a prior randomized clinical trial at eight nontertiary hospitals (2020-2021) in Ghana. In this trial, there was a baseline (before) period, after which the TIF was introduced. TIF use and achievement of 16 KPIs were recorded by trained observers.

Results: We enrolled 2067 patients (before period) and 2010 patients (after period), of whom 1720 had the TIF used and 290 did not. Patients who did not have the TIF used were more likely to be < 18 years, treated at first-level hospitals, treated during off-hours, and less likely to be seriously injured (ISS ≥ 9) than patients who had the TIF used (all p < 0.05). Patients who had the TIF used were more likely to have 11/16 KPIs performed compared to those who did not have the TIF used. For example, chest examination was performed in 99.5% of patients who had the TIF used versus 80% of those who did not (p < 0.001). Comparing all three groups as follows: Before the TIF (baseline), 2/16 KPIs were performed in ≥ 90% of patients. After TIF introduction, in the group in which the TIF was used, this increased to 15/16 KPIs being performed in ≥ 90% of patients. However, in the after period, but without TIF use, 4/16 KPIs were performed in ≥ 90% of patients, which was higher than baseline but not as high as with TIF use.

Conclusions: TIF use led to improved care. Care of patients who did not have the TIF used improved compared to the before period, suggesting hospital-wide improvements. This improvement was modest, indicating that TIF use in all trauma patients remains the goal. Groups with low TIF usage should be the focus for efforts to improve TIF usage and trauma care in future trials and quality improvement efforts.

Trial registration: ClinicalTrials.gov: NCT04547192.