Improving emergency department trauma care in Fiji: Implementing and assessing the trauma call system

Abstract

Objective: The trauma team process was recently implemented at the Colonial War Memorial (CWM) Hospital, Suva. This study audits the trauma call procedure at the hospital over a period of 12 months. Method: Retrospective descriptive study of trauma calls from August 2015 to July 2016 at CWM Hospital. Data relating to patient demographics, time of presentation, time to team assembly and time to computed tomography (CT) scan were extracted from the ED trauma call database. Disposition from the ED and status at hospital discharge was extracted from the hospital patient information system. Results: There were 38 trauma calls for 46 patients. Seventy-two per cent were male. Eighty-two per cent occurred when the CT radiographer was off site (16.00-08.00 h), including 47% that occurred between midnight and 08.00 h. Fifty-two per cent of patients were intubated, 43% went to ICU, 26% went directly to the operating theatre, and 37% died. Benchmarks for time to trauma team assembly and time to CT scan were met in 50% of cases. Conclusion: This was a severely injured cohort of patients with a high mortality rate. The rate of missed calls was not assessed in this study. Time to CT scan could be improved with an onsite radiographer. Time to team assembly could be improved with trauma team training and early notification from pre-hospital providers. There is a need to continue to monitor and refine the trauma call process and to extend data capture to measure injury severity and outcomes.

World Health Assembly Resolution 72.16: What are the implications for the Australasian College for Emergency Medicine and emergency care development in the Indo‐Pacific?

“…Publications from the region provide insights into EC needs and demonstrate how effective interventions can be developed and implemented at low cost. In Fiji, trauma management has been improved through enhanced surveillance and team‐based care; in Papua New Guinea, action research has helped optimise asthma treatment; and in the Solomon Islands, inconsistent triage (a challenge in many Pacific Island countries) has been addressed by a simple, locally developed triage system . Despite experiencing significant disasters, Indonesia and Myanmar have only recently developed specialty training in emergency medicine (EM) and have identified that the crucial pre‐hospital EC needs can be assisted by simple rural systems and basic protocols …”

Emergency care status, priorities and standards for the Pacific region: A multiphase survey and consensus process across 17 different Pacific Island Countries and Territories

“…Most EC stakeholders reported using a standardised resuscitation guideline at their national hospital, but agreed that further guideline development with widespread and consistent implementation was a priority. Examples of evidence-based, context appropriate clinical guidelines to improve EC exist for trauma care in Fiji [40] and acute asthma in PNG, [41] as well as a framework for developing and sharing locally adapted clinical EC guidelines. [42] The need for pre-hospital clinical practice guidelines is highlighted in Timor-Leste, [43] as one component of many essential Process priorities and standards required to build an effective prehospital system.…”

Achievement of Key Performance Indicators in Initial Assessment and Care of Injured Patients in Ghanaian Non‐tertiary Hospitals: An Observational Study

“…Most injury assessment KPIs were achieved in < 40% of patients in Iran, with improvements when checklists were used [18]. Similarly, time for trauma team assembly and time to computerized tomography were achieved in 50% and 56%, respectively, in a Fijian study [19]. Conversely, the Australia‐India Trauma Systems Collaborative reported a rate of missingness of < 20% for most KPIs [20].…”