From targets to solutions: Implementing a trauma quality improvement bundle in Cameroon.

Area of Science:

• Global surgery
• Trauma care quality improvement
• Health systems research

Background:

• Global surgery research often struggles to move from identifying problems to implementing solutions.
• Care gaps in trauma resuscitation exist in resource-limited settings.
• A context-appropriate trauma quality improvement (TQI) bundle was developed for a regional hospital in Cameroon.

Purpose of the Study:

• To implement a TQI bundle to address trauma care deficits.
• To determine the association between TQI bundle implementation and improved trauma resuscitation practices.

Main Methods:

• A TQI bundle included a trauma protocol, staff training, checklist, essential supplies, and quality improvement meetings.
• Process measures of trauma resuscitation were compared pre- and post-bundle implementation.
• Statistical analyses (Wilcoxon rank-sum, Fisher's exact tests) were used for comparison.

Main Results:

• Post-bundle implementation saw a significant increase in vital sign collection (69% vs 0%) and timely measurement (90% within 15 min vs 74%).
• Frequency of vital sign collection per patient increased substantially (52% vs 7%).
• Key interventions like respiratory support (8% vs 1%) and cervical collar placement (7% vs 0%) also showed significant improvement.

Conclusions:

• A context-specific TQI bundle significantly improved trauma care deficits at a regional hospital.
• Data-driven interventions at the local level can effectively bridge the gap between identifying and improving care limitations.
• This approach is valuable for resource-limited settings to enhance trauma resuscitation.