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Trauma Quality Improvement in Low and Middle Income Countries of the Asia–Pacific Region: A Mixed Methods Study

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Abstract

Background

Quality Improvement (QI) programs have been shown to be a valuable tool to strengthen care of severely injured patients, but little is known about them in low and middle income countries (LMIC). We sought to explore opportunities to improve trauma QI activities in LMIC, focusing on the Asia–Pacific region.

Methods

We performed a mixed methods research study using both inductive thematic analysis of a meeting convened at the Royal Australasian College of Surgeons, Melbourne, Australia, November 21–22, 2010 and a pre-meeting survey to explore experiences with trauma QI activities in LMIC. Purposive sampling was employed to invite participants with demonstrated leadership in trauma care to provide diverse representation of organizations and countries within Asia–Pacific.

Results

A total of 22 experts participated in the meeting and reported that trauma QI activities varied between countries and organizations: morbidity and mortality conferences (56 %), monitoring complications (31 %), preventable death studies (25 %), audit filters (19 %), and statistical methods for analyzing morbidity and mortality (6 %). Participants identified QI gaps to include paucity of reliable/valid injury data, lack of integrated trauma QI activities, absence of standards of care, lack of training in QI methods, and varying cultures of quality and safety. The group highlighted barriers to QI: limited engagement of leaders, organizational diversity, limited resources, heavy clinical workload, and medico-legal concerns. Participants proposed establishing the Asia–Pacific Trauma Quality Improvement Network (APTQIN) as a tool to facilitate training and dissemination of QI methods, injury data management, development of pilot QI projects, and advocacy for quality trauma care.

Conclusions

Our study provides the first description of trauma QI practices, gaps in existing practices, and barriers to QI in LMIC of the Asia–Pacific region. In this study we identified opportunities for addressing these challenges, and that work will be supported by APTQIN.

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Acknowledgments

The authors are grateful to Charlie Mock for advice and support in planning the meeting and Ebony Gilbee for data collection. The project was supported by the Canadian Institutes of Health Research (Meeting Grant FRN-101999), the Australian Agency for International Development (AusAID) through its International Seminar Support Scheme, and the National Trauma Research Institute (NTRI) of Australia. The workshop was hosted by the NTRI and The Alfred Hospital. The Royal Australasian College of Surgeons provided the venue for the workshop. Dr. Stelfox is supported by a New Investigator Award from the Canadian Institutes of Health Research and a Population Health Investigator Award from Alberta Innovates. Dr. Gruen is supported by a Career Development Award from the Australian National Health and Medical Research Council. Funding sources had no role in the design, conduct, or reporting of this study, and we are unaware of any conflicts of interest. None of the authors have financial or professional conflicts of interest that would influence the conduct or reporting of this study. Drs. Stelfox and Gruen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. A version of the manuscript was presented at the 2011 International Association for Trauma Surgery and Intensive Care (IATSIC) section of the International Surgical Society Meeting, Yokohama, Japan.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Medicine and Community Health Sciences, Institute for Public Health, University of Calgary, Teaching Research & Wellness Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada

    Henry Thomas Stelfox

  2. Academy of Traumatology, Ahmedabad, India

    Manjul Joshipura

  3. Khon Kaen Hospital, Khon Kaen, Thailand

    Witaya Chadbunchachai

  4. College of Surgeons, Colombo, Sri Lanka

    Ranjith N. Ellawala

  5. Emergency and Trauma Centre, The Alfred Hospital, Monash University, Melbourne, Australia

    Gerard O’Reilly

  6. Duc Giang Hospital, Hanoi, Vietnam

    Thai Son Nguyen

  7. The National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Australia

    Russell L. Gruen

Authors
  1. Henry Thomas Stelfox
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  2. Manjul Joshipura
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  3. Witaya Chadbunchachai
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  4. Ranjith N. Ellawala
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  5. Gerard O’Reilly
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  6. Thai Son Nguyen
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  7. Russell L. Gruen
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Corresponding author

Correspondence to Henry Thomas Stelfox.

 

 

Appendix 1 Meeting participants
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Appendix 2
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Survey instrument

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Stelfox, H.T., Joshipura, M., Chadbunchachai, W. et al. Trauma Quality Improvement in Low and Middle Income Countries of the Asia–Pacific Region: A Mixed Methods Study. World J Surg 36, 1978–1992 (2012). https://doi.org/10.1007/s00268-012-1593-1

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