Pilot Implementation of a Multi-Site Injury Surveillance Registryin Haiti Público

Abstract

Background: Development of a trauma surveillance system has become a national priority for Haiti. In 2014, a trauma needs capacity assessment was conducted in 12 hospitals across 9 departments, as described in the WHO Guidelines for Essential Emergency and Surgical Care. Step two of the guidelines recommends development of standardized data-collection protocols, which allow for monitoring of disease burden and overall health outcomes. In this article, we present our pilot evaluation of implementing a new Injury Surveillance logbook with four Haitian Emergency Departments, specifically looking at the implementation within existing workflow processes and feasibility for tracking patients with trauma or injuries.

Methods: We designed a provider-based trauma and injury registry utilizing WHO Injury Surveillance Guidelines, existing trauma registries from other Low and Middle Income Countries, and with consideration for existing documentation systems in Haiti. The logbook was tested in four Haitian Emergency Departments for four weeks. Utility of the logbook was evaluated using quantitative indicators from WHO Injury Surveillance Guidelines (injury rate, recording score, completeness score, and accuracy score) and post-pilot survey responses from providers. Qualitative data was collected from users and was coded and analyzed using inductive methods.

Findings: Recording rates by staff ranged from 25% to 58%, and correlated with time of day, week of study, and hospital staffing at sites. Entry completeness rates ranged from 43-80%. The most frequently recorded variables pertained to mechanism (96%), location (95%), and type of injury (92%), as well as procedures performed (90%). Most commonly missed variables included vital signs (60%) and number of severe injuries (65%). Providers reported high agreeability with using the form (p<0.01). The most commonly cited barrier to using the form was 'lack of time'.

Interpretation: This format of an injury surveillance logbook was integrated into the natural workflow of patient care in Haitian Emergency Departments. The feasibility statistics demonstrate that there are areas in the tool that could be improved, but overwhelmingly there is support for the surveillance system to be used nationwide. Future steps include extending the trial period for an additional 6 months, and incorporating more facilities in surveillance of trauma.

Table of Contents

Abstract

Manuscript:

-Background

-Methods

-Results

-Conclusions/Discussion

Tables and Figures

-Tables 1-3, Figures 1-8

Appendix

About this Master's Thesis

Rights statement

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	Injury Surveillance Global Surgery National Trauma System Low and Middle Income Country
Committee Chair / Thesis Advisor	Ali, Mohammed K, Emory University
Partnering Agencies	Community-based non-profit organization (e.g., AID Atlanta) Non-US governmental agency (e.g., Minister of Health in Haiti)

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