Introduction Table 2. Core Implementation Issues ... · into T6. T6 cannot replace the handwritten patient records which are indispensable to ensure continuation of the local clinical

Introduction

Methods

Implementation of an electronic trauma registry in Calixto García Hospital is feasible provided that the following fundamental changes are made:

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Citations

1. Mehmood A, Razzak JA: Trauma registry—needs and challenges in developing countries. J Pak Med Assoc 2009, 59:807–808.2. World Health Organization. 10 facts on injuries and violence. Geneva: World Health Organization; 2008. Available at: http:// www.who.int/features/factfiles/injuries/en/index.html. Accessed October 20, 2013.3. Schultz CR, Ford HR, Cassidy LD, Shultz BL, Blanc C, King-Schultz LW, et al. Development of a hospital-based trauma registry in Haiti: an approach for improving injury surveillance in developing and resource-poor settings. J Trauma. 2007; 63:

1143–1154.4. Chichom-Mefire A, Nwanna-Nzewunwa OC, Siysi VV, Feldhaus I, Dicker R, Juillard C. Key findings from a prospective trauma registry at a regional hospital in Southwest Cameroon. PLoS One. 2017;12(7):e0180784.5. Dasari, Mohini & Asturias, Sabrina & Garbett, Marcelo & Zargaran, Eiman & Machain, Gustavo & Hameed, Morad & Carlos Puyana, Juan. (2016). 6. Implementing Electronic Surgical Registries in Lower-Middle Income Countries: Experiences in Latin America. Annals of Global Health. 82. 639-643. 10.1016/j.aogh.2016.09.007.Electronic Surgical Registries in Lower-Middle Income Countries: Experiences in Latin America. Annals of Global Health. 82. 639-643. 10.1016/j.aogh.2016.09.007.

All graphics used in figure 1 retrieved fom: https://www.pinclipart.com, https://123clipartpng.com/? and https://www.iconfinder.com. See abstract references addendum for full citations.

• 5.8 million people die every year from traumatic injuries1.

• Over 90% of these deaths occur in low- to middle-income countries2.

• A major contributing factor to the high trauma incidence and burden in LMICs is the inconsistent degree of hospital injury surveillance initiatives3.

• Pilot programs in other LMICs have shown improvements in traumatic injury data collection as a result of implementing electronic trauma registries4,5,6.

• Hypothesis: Implementation of an electronic trauma registry in this setting is feasible with necessary modifications.

Conclusions

Implementation of a Tablet-Based Electronic Trauma Registry in a Cuban Hospital: a Feasibility Study

Celestino Castanon1, Martha Ester Larrea Fabra MD2, Susana Celestrín Marcos MD2, Marc A. de Moya MD1

1Medical College of Wisconsin (MCW), 2Hospital General Calixto García.

Acknowledgements: Funded by the MCW Office of Global Health Dr. Elaine Kohler Summer Academy of Global Health Research. Site visits guided by Wilfredo Santiesteban Herrera2

• Ten focus group meetings were held over a period of 2 months with department chiefs, head of the hospital research committee and various clinical staff to determine the most useful documentation elements in the trauma bay and emergency department.

• Site visits were also conducted by visiting medical students to better understand the flow of trauma patients and emergency department dynamics.

• Interview transcripts were coded and recurring themes concerning the implementation of T6 were categorized. These themes were then analyzed to determine feasible solutions.

Structural Code Text Code Theme

Application UI Simplification Issues

“The UI has too many items and complicated that would not be used or are distracting. It may take too much time to record the required

data in addition to the required handwritten patient record.”User friendly

Simple

Language and Cultural Barriers

“It needs to be in Spanish so it can be generalized and applied at other locations in the future, since that is the ultimate goal.”

Communication

Application Compatibility and Adaptability Issues

“If the application could be easily transferred between devices, personal tablets and phones used by doctors could possibly be

integrated into the T6 database.”

Technology supportData sharing

Adapting to local clinical workflow

Local Protocols and Team Dynamic Issues

“There is not enough personnel to have one person solely dedicated to inputting data into the T6 application.”

Local and international project oversight

Local Team Data Recording Interests

“We are very interested in recording temporal data points, such as the time of the accident, time of arrival, time of primary survey and time of

surgical interventions.”

Trauma patient timelines

Tracking inventory

Table 2. Core Implementation Issues Identified and Proposed Solutions. The most challenging problems in the implementation of T6 in Calixto García Hospital involve adapting the app to the current documentation protocols and personnel limitations. This means that significant changes must be made in the app UI to simplify it and better adapt it to the working ED and trauma bay team dynamics and clinical workflow.

Major Issue Proposed SolutionsLacking personnel and time required to input data into T6 may

preclude its use.1. Assign rotating medical students or nurses to input information

into T6.

T6 cannot replace the handwritten patient records which are indispensable to ensure continuation of the local clinical workflow.

1. Print salient T6 data to be addended to the patient records.2. Input data into T6 retrospectively using handwritten notes.

Even if T6 could be used without any technical difficulties, the menus are too complex and the numerous data fields could

discourage its use.

1. Simplify the application UI to only record the data of most interest and use for hospital staff.

2. Allow for ongoing app updates that could add or remove data fields per user requests.

ResultsTable 1. Abridged Thematic Analysis of Focus Group Meeting Transcripts. The most frequently expressed concerns regarding the app itself focused on the complexity of the user interface (UI), lack of menus in Spanish as well as its limited compatibility with Android and Windows-based tablets and phones. Issues regarding the change of team dynamics and clinical workflow to fit the use of T6 were the second most-mentioned problem.

Figure 1. Proposed Simplified Application Design. This graphic represents an example of how the menus of the revised T6 app main menu would look like when taking into account the comments and revisions from the focus group meetings. This design prioritizes 7 key time points of interest, as well as the most essential aspects of the primary survey and subsequent management of traumatic injuries. This model sets out realistic expectations for the documentation of concise yet significantly useful data. The recorded information can be easily itemized in an electronic trauma registry database with the goal of facilitating retrospective analyses of trauma cases and the planification of future quality improvement programs.

1. Identify and assign specific personnel to input data into T6.2. Continue to generate paper copies of patient records concurrently.3. Set up an internal server within the hospital to store T6 data or adapt the application to an Android-based platform.

Basic Info.Age

Sex

Skin Color

Co-morbidities

Allergies

Pre-Hospital Hospital Arrival Primary Survey Definitive Management

Time of injury Start time of pre-

hospital care

Mechanism of Injury:

• Triage Level: ���

Pre-Hospital Interventions:

Mode of Transportation

Hospital Arrival

In Shock? �

• Triage Level:

Revised Trauma Score: 0 - 12

Start time of trauma

evaluation

Time of Primary

assessment completion

Initial Diagnosis:

Time of initial diagnosis Time of surgical

and/or therapeutic interventions

Complications:

Therapeutic Interventions:

Surgical Interventions:

VITAL SIGNSHeart Rate:

Respiratory Rate:

Blood Pressure:

Airway

Breathing

Circulation

Disability

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