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

Abstract

Introduction We aimed to determine the level of achievement of key performance indicators (KPIs) during initial assessment and management of injured persons, as assessed by independent observers, at district and regional hospitals in Ghana. Methods Trained observers were stationed at emergency units of six district (first level) and two regional (referral) hospitals, from October 2020 to February 2021, to observe management of injured patients by health service providers. Achievement of KPIs was assessed for all injured patients and for seriously injured patients (admitted for C 24 h, referred, or died). Results Management of 1006 injured patients was observed. Road traffic crash was the most common mechanism (63%). Completion of initial triage ranged from 65% for oxygen saturation to 92% for mobility assessment. For primary survey, airway was assessed in 77% of patients, chest examination performed in 66%, and internal abdominal bleeding assessed in 43%. Reassessment rates were low, ranging from 16% for respiratory rate to 23% for level of consciousness. Thirty-one percent of patients were seriously injured. Completion of KPIs was higher for these patients, but reassessment remained low, ranging from 25% for respiratory rate to 33% for level of consciousness. Conclusion KPIs were performed at a high level, but several specific elements should be performed more frequently, such as oxygen saturation and assessment for internal abdominal bleeding. Reassessment needs to be performed more frequently, especially for seriously injured patients. Overall, care for the injured at non-tertiary hospitals in Ghana could be improved with a more systematic approach.

Differences in trauma care between district and regional hospitals and impact of a trauma intake form with decision support prompts in Ghana: A stepped‐wedge cluster randomized trial

“…Details of study procedures, including data collection methods, hospital sampling, and power estimation, have been previously described. 11,16 Briefly, trained research assistants (RAs) observed and documented initial assessment and care of injured patients at EUs of study hospitals for an initial period of 3.5 months. The TIF was then introduced to 2 nearby hospitals, selected by simple random sampling, after training the EHSPs on its use.…”