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Mixed methods process evaluation of pilot implementation of the African Federation for Emergency Medicine trauma data
Adam D Laytin1,2, Aklilu Azazh3, Biruk Girma3
1University of California San Francisco, Department of Surgery, Center for Global Surgical Studies, 1001 Potrero Ave, Building 1, Room 400, San Francisco, CA 94110, USA.
Insights
Implementing the African Federation for Emergency Medicine Trauma Data Project (AFEM-TDP) protocol in Ethiopia showed early successes in patient care and training, but faced challenges with data capture rates and supervision. Adaptations are needed for better implementation in resource-limited settings.
Area of Science:
- Emergency Medicine
- Public Health
- Health Informatics
Background:
- The African Federation for Emergency Medicine Trauma Data Project (AFEM-TDP) developed a standardized trauma data collection protocol for resource-limited settings.
- Implementation of this protocol was assessed at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia.
Purpose of the Study:
- To conduct a process evaluation of the AFEM-TDP protocol's implementation.
- To identify successes and challenges in data collection and inform protocol adaptation for the local setting.
Main Methods:
- A mixed-methods approach was used, including assessment of data quality during pilot collection.
- Structured key informant interviews were conducted and analyzed using a SWOT model.
Main Results:
- Pilot data collection achieved a 21% overall capture rate, with high frequency for demographics, vital signs, and ED diagnosis, but low for mechanism of injury and ED disposition.
- SWOT analysis revealed strengths (improved patient care, training) and weaknesses (supervision, form size), with opportunities (research) and threats (lack of champion, funding).
Conclusions:
- Mixed-methods process evaluations are crucial for implementing novel data collection protocols in resource-limited environments.
- Early successes and challenges were identified, leading to strategies for adapting the AFEM-TDP protocol.
- Lessons learned can guide future research on similar data collection protocols.
Introduction:
The African Federation for Emergency Medicine Trauma Data Project (AFEM-TDP) has created a protocol for trauma data collection in resource-limited settings using a clinical chart with embedded standardized data points that facilitates a systematic approach to injured patients. We performed a process evaluation of the protocol's implementation at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia to provide insights for adapting the protocol to our setting.
Methods:
During the pilot implementation period, the quality of collected data was assessed. Structured key informant interviews about participant experiences and perceptions of the protocol implementation were then conducted. Interviews were analysed using a SWOT model.
Results:
During pilot data collection, the overall capture rate was 21%. Variables collected with high frequency included demographics, vital signs and ED diagnosis, while mechanism of injury and ED disposition were often missed. Key informant interviews identified Strengths, Weaknesses, Opportunities and Threats to the protocol. Strengths included improved patient care, enhanced training for junior providers and facilitated data collection. Weaknesses included inadequate supervision and challenges relating to the physical size of the form, which resulted in missing data. Opportunities included retrospective research and quality improvement work. Threats included perceived lack of a local champion, poor buy-in from other hospital departments and need for ongoing financial support.
Conclusion:
A mixed methods process evaluation is an invaluable tool when implementing novel data collection protocols, especially in resource-limited settings. We determined early successes and challenges of the implementation of the AFEM-TDP protocol and generated strategies to adapt the protocol to better suit our setting. Lessons from this process evaluation may be informative for other researchers designing and implementing similar data collection protocols.
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