Trauma care and capture rate of variables of World Health Organisation data set for injury at regional hospitals in Tanzania: first steps to a national trauma registry

Abstract

Background: In Tanzania, there is no national trauma registry. The World Health Organization (WHO) has developed a data set for injury that specifies the variables necessary for documenting the burden of injury and patient-related clinical processes. As a first step in developing and implementing a national Trauma Registry, we determined how well hospitals currently capture the variables that are specified in the WHO injury set. Methods: This was a prospective, observational cross-sectional study of all trauma patients conducted in the Emergency Units of five regional referral hospitals in Tanzania from February 2018 to July 2018. Research assistants observed the provision of clinical care in the EU for all patients, and documented performed assessment, clinical interventions and final disposition. Research assistants used a purposefully designed case report form to audit the injury variable capture rate, and to review Ministry of Health (MoH) issued facility Register book recording the documentation of variables. We present descriptive statistics for hospital characteristics, patient volume, facility infrastructure, and capture rate of trauma variables. Results: During the study period, 2891 (9.3%) patients presented with trauma-related complaints, 70.7% were male. Overall, the capture rate of all variables was 33.6%. Documentation was most complete for demographics 71.6%, while initial clinical condition, and details of injury were documented in 20.5 and 20.8% respectively. There was no documentation for the care prior to Emergency Unit arrival in all hospitals. 1430 (49.5%) of all trauma-related visits seen were documented in the facility Health Management Information System register submitted to the MoH. Among the cases reported in the register book, the date of EU care was correctly documented in 77% cases, age 43.6%, diagnosis 66.7%, and outcome in 38.9% cases. Among the observed procedures, initial clinical condition (28.7%), interventions at Emergency Unit (52.1%), investigations (49.0%), and disposition (62.9%) were documented in the clinical charts. Conclusions: In the regional hospitals of Tanzania, there is inadequate documentation of the minimum trauma variables specified in the WHO injury data set. Reasons for this are unclear, but will need to be addressed in order to improve documentation to inform a national injury registry.

Development and pilot implementation of a standardised trauma documentation form to inform a national trauma registry in a low-resource setting: lessons from Tanzania

“…The preplanned interim analysis 30 days after Open access implementation included 925 patients seen by 23 clinicians, and found overall data completion and errors improved substantially across all categories (figure 2). The overall documentation increased from baseline in the diagnostic phase (33.6%) in July 2018 19 to 96.3% at 7-month post implementation, a substantial improvement from 33.6% observed during the 'diagnostic' phase, and improvement was across all categories (table 1). Details of injury (from 20.7% to 96.2%), initial clinical condition (from 26% to 96.5%) and injury examination (from 27.5% to 94.6%) had the largest improvements in documentation (table 1).…”

“…Then, the proportion of documented DSI variables during the study period was compared with the proportion captured during the initial needs assessment (when the standardised form did not exist and only existing records were evaluated). 19 DSI variables were aggregated into five main categories to demonstrate the change in the proportion of variables completed from baseline to 7-months post implementation.…”

“…A participatory action research study was conducted between 1 February 2018 and 30 September 2019 at five regional referral hospitals in Tanzania (Morogoro, Arusha, Mwananyamala, Coastal and Tanga). 19 The process of development and implementation of a system to collect standardised trauma variables was guided by Susman and Evereds' cyclic process of inquiry for action research 21 (figure 1). The first two phases of this process ('diagnosis' and 'action planning') were previously undertaken during the aforementioned needs assessment studies, 19 20 22 and are briefly described here.…”

“…This revealed poor capture (33.6%) of the recommended variables. 19 Following this analysis, we conducted a qualitative study using focus groups at these five hospitals to understand the barriers and facilitators for capturing required data. 20 Among the barriers were provider knowledge, and the burden of dual documentation.…”

“…Then, the top copy could be removed to become part of the patient's chart, while the bottom copy was retained to inform the registry. In each EU, research assistants-clinical officers (middle level providers with diploma in clinical medicine) and nurses received extensive training on how to capture data electronically, and prior to this phase of the study, they all had participated in data collection for the baseline observational study, 19 reported in the diagnostic phase.…”