Injuries Major, Major Trauma
Conditions
Keywords
Quality improvement, Injury, Injuries
Brief summary
A prospective before-and-after study to evaluate the effect of implementing a Trauma Quality Improvement protocol on the process of Trauma Quality Improvement meetings and major trauma patient outcomes at four trauma centres in India.
Detailed description
This project will be conducted as a prospective before-and-after study at four major trauma centres in India, with the intervention occurring between pre- and post-intervention phases. Included in the study will be all patients presenting to any of the four trauma hospitals with a potentially life-threatening or limb-threatening injury. The intervention will be the introduction of a structured Trauma Quality Improvement Meeting (TQIM), using a checklist and training program. The primary outcome will be compliance with the TQIM checklist, measured as the proportion of discussed cases (trauma deaths) for which problems with care, preventability and corrective actions were discussed and / or agreed. The secondary outcomes will include in-hospital risk-adjusted mortality, hospital length of stay and time to emergency surgery. Data collection will occur at all meetings at the four trauma hospitals at which trauma deaths are discussed. Data will also be collected in a dedicated trauma registry.
Interventions
OTHERTQIM checklist
The intervention phase will include an intense training period covering: 1. Conduct of Trauma Quality Improvement Meeting (TQIM) (and Trauma Quality Improvement program in general). The training will be delivered using the World Health Organization (WHO) Trauma Quality Improvement Programmes short course and online resources. 2. Implementation of Trauma Quality Improvement Meeting (TQIM) Checklist.
Sponsors
National Trauma Research Institute
The Alfred
Monash University
All India Institute of Medical Sciences
The George Institute for Global Health, Australia
Sheth Vadilal Sarabhai General Hospital
Guru Teg Bahadur Hospital
Lokmanya Tilak Municipal Medical College and Hospital
Centralised Accident and Trauma Services, Delhi, India
GVK EMRI: Emergency Management and Research Institute
Maharashtra Emergency Medical Services, India
Nathiba Hargovandas Lakhmichand Municipal Medical College, India
University College of Medical Sciences, India
Dr Gerard O'Reilly
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* All patients presenting to any of the four study sites with a potentially life-threatening or limb-threatening injury. Specifically, all presenting injured patients triaged as Red or Yellow according to the Australia-India Trauma Systems Collaboration (AITSC) Trauma Triage Protocol, will meet the screening criteria for data collection. Retrospective inclusion in the registry will be continued for all screened patients presenting to any of the included hospitals with injury (including near-drowning) as the primary diagnosis and with at least one of the following criteria: * Admission to hospital * Death after triage but before admission
Exclusion criteria
* The
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| TQIM Checklist compliance - preventability | Up to 14 months | TQIM Checklist compliance - % of cases for which it is agreed that care can be improved |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| TQIM Checklist compliance - corrective action | Up to 14 months | TQIM Checklist compliance - % of cases (where it is agreed that care can be improved) for which at least one corrective action is agreed |
| In hospital risk-adjusted mortality | Up to 14 months | In-hospital risk-adjusted mortality: The proportion of deaths amongst those with Injury Severity Score (ISS) \>12 and \<50. |
| Hospital length of stay | Up to 14 months | Hospital length of stay |
| Time to emergency surgery | Up to 14 months | Time from hospital arrival to operating theatre for patients undergoing emergency surgery |
Countries
India
Outcome results
None listed