Developing Trauma Audit Filters for Regional Referral Hospitals in Cameroon: Mixed-Methods Approach

Wu, Nancy; Carvalho, Melissa; Nwanna-Nzewunwa, Obieze; Nana, Théophile; Motwani, Girish; Mbeboh, Susana N.; Chendjou, William; Nour, Fonje Mouansie Ahmed; Christie, S. Ariane; Mefire, Alain Chichom; Dicker, Rochelle; Juillard, Catherine

doi:10.1016/j.jss.2018.07.048

Cited by 5 publications

(10 citation statements)

References 22 publications

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“…The audit filters defined in Cameroon 9 and Ghana 10 were deemed highly useful in the urban Indian setting. The filters from Cameroon were focused on regional referral hospitals, while those defined in Ghana were intended for use in district-level hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…We included previously published trauma audit filters intended for use in LMICs. These filters included those from the WHO guidelines, 7 as well as filters in one study from Cameroon 9 and one from Ghana. 10 In total, 67 audit filters were identified with 47 from Cameroon 9 and Ghana 10 and 20 from WHO guidelines.…”

Section: Methodsmentioning

confidence: 99%

“…These filters included those from the WHO guidelines, 7 as well as filters in one study from Cameroon 9 and one from Ghana. 10 In total, 67 audit filters were identified with 47 from Cameroon 9 and Ghana 10 and 20 from WHO guidelines. 7 We did not deem it feasible to score and comment on all 67 filters at each site and therefore the India-based TAFT core research team conducted an internal online Delphi survey to remove duplicate filters, prioritise filters potentially appropriate for the urban setting in India and evaluate the online tool used for this study.…”

Section: Methodsmentioning

confidence: 99%

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Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries

et al. 2022

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ObjectiveTo compare experts’ perceived usefulness of audit filters from Ghana, Cameroon, WHO and those locally developed; generate context-appropriate audit filters for trauma care in selected hospitals in urban India; and explore characteristics of audit filters that correlate to perceived usefulness.DesignA mixed-methods approach using a multicentre online Delphi technique.SettingTwo large tertiary hospitals in urban India.MethodsFilters were rated on a scale from 1 to 10 in terms of perceived usefulness, with the option to add new filters and comments. The filters were categorised into three groups depending on their origin: low and middle-income countries (LMIC), WHO and New (locally developed), and their scores compared. Significance was determined using Kruskal-Wallis test followed by Wilcoxon rank-sum test. We performed a content analysis of the comments.Results26 predefined and 15 new filter suggestions were evaluated. The filters had high usefulness scores (mean overall score 9.01 of 10), with the LMIC filters having significantly higher scores compared with those from WHO and those newly added. Three themes were identified in the content analysis relating to medical relevance, feasibility and specificity.ConclusionsAudit filters from other LMICs were deemed highly useful in the urban India context. This may indicate that the transferability of defined trauma audit filters between similar contexts is high and that these can provide a starting point when implemented as part of trauma quality improvement programmes in low-resource settings.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries

et al. 2022

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“…Ainda na perspectiva de contribuições da auditoria para a qualificação de processos assistenciais e gerenciais, destacam-se as produções que se referiram às mudanças e/ou incentivos para a implementação de protocolos e/ou diretrizes clínicas, condutas, mudanças de práticas profissionais, monitoramento de indicadores para qualificar a assistência aos pacientes e adequar o uso de recursos (BAILEY;BINHB;BANG, 2010;DEMARCHI et al, 2012;FAROOQ et al, 2013;GRAUDINS et al, 2015;HOFMAN;MOHAMMED, 2014;JOHRI et al, 2017;KAYIGA et al, 2016;KHALIL et al, 2017;MILLER et al, 2018;PLOTKIN et al, 2018;RODRIGUES et al, 2018;SAYINZOGA et al, 2016;SCOTT;BEVERIDGE;NICHRÓNÍN, 2016;WU et al, 2018).…”

Section: A Auditoria Na Qualificação De Processos Assistenciais E Gerunclassified

“…Em um estudo desenvolvido por Wu et al (2018), em três hospitais na África, aplicou filtros de auditoria que foram desenvolvidos consensualmente por médicos com experiência em traumatologia. A aplicação desse instrumento, no processo de atendimento de vítimas de trauma, constatou que o uso da auditoria permitiu obter dados relevantes sobre a ocorrência e as taxas de eventos adversos, complicações No estudo de Plotkin et al (2018), realizado em todas as unidades de saúde da região Kagera, no noroeste da Tanzânia, objetivou determinar a sensibilidade e a especificidade dos registros de óbito perinatal lançados no HMIS para comparar com os registros de uma auditoria padrão-ouro.…”

Section: A Auditoria Na Qualificação De Processos Assistenciais E Gerunclassified

Contribuições da auditoria na gestão hospitalar: revisão integrativa

Fabro¹

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The health audit is considered a tool to assist in the management of health services.Through its application, it is possible to obtain a situational diagnosis to intervene in order to obtain changes and improvements; however, there are controversies regarding its accounting-financial and/or assistance quality approach, varying this focus in different contexts and situations, both in the Unified Health System and in supplementary health. The objective of this study is to analyze the scientific knowledge produced about auditing and its contribution to management in hospital care. It is an integrative review, guided by the question "What are the scientific evidences about auditing as a contribution to management in hospital care?", which went through five stages for its elaboration. The primary studies were selected in the LILACS, MEDLINE databases via PubMed, Scopus, Embase and Web of Science.The sample of the integrative review was composed of 18 studies, which were inserted and stored in the EndNote Basic software. To systematize the selected articles, the Rayyan software was used, and for the analysis of similarity of words, Iramuteq was used. The selection of the articles was done in a double conference by two researchers, independently. After the synthesis, the studies were grouped into two categories. "The audit on the qualification of assistance and management processes" groups 16 articles, which bring different strategies, such as the educational process and the implementation of assistance protocols/guidelines, which enable the planning and decision making by the manager to qualify the assistance. The category "Audit and cost management" groups five articles, which bring an important contribution in relation to the adequacy of expenses and costs to redistribute and optimize the resources involved in patient care. The scientific evidence includes knowledge about auditing, which favors hospital management, mainly in interventions for the review and improvement of assistance processes, the implementation of clinical protocols, and the promotion of actions that involve the educational process and the reflection of practice by professionals, providing quality assistance and also enabling cost management.

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Effects of trauma quality improvement program implementation on mortality: A multi-center controlled interrupted time-series study

Berg,

David,

Bakhshi

et al. 2024

Preprint

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Importance: Trauma causes over four million deaths annually, the majority of these in low− and middle−income countries. Implementing trauma quality improvement programs may improve outcomes, and though extensively used, high−quality evidence of their effectiveness is scarce. Objective: To assess if implementing a trauma quality improvement program using on audit filters improves trauma patients outcomes. Design: A controlled interrupted time-series study, the Trauma Audit Filter Trial (TAFT). Setting: A prospective, multi−center study across four tertiary care hospitals in urban India. Participants: Adult patients admitted to participating hospitals with a history of trauma, defined as having any of the external causes listed in block V01-Y36, chapter XX of the International Classification of Disease version 10 as reason for admission. Intervention: In the intervention arm, comprised of two hospitals, we implemented a trauma quality improvement program using audit filters after an observation period of one year. The remaining two hospitals, the control arm, continued baseline data collection during the entire study period, 2017 − 2022, with no intervention made. Main Outcomes: All−cause mortality (in−hospital and at 30 days). For time series analysis, we applied segmented regression with a generalized additive model (GAM) to assess the effect on in−hospital mortality. We performed secondary analysis applying difference−in−differences analysis with linear regression to assess the effect on in−hospital and 30−day mortality. The study was not adequately powered to do time series analysis on 30−day mortality. Results: We included 10143 patients, median age 35 (IQR 26 − 50), 83% men. Using time series analysis, we observed a significant reduction in in-hospital mortality (32% vs 24%; OR 0.57, 95% CI 0.41−0.79, p<0.001) in the intervention arm, with no significant change in the control arm. Using difference-in-differences analysis we found a significant reduction in 30-day mortality (39% vs 26%; −0.15 95% CI -0.19 to −0.11, p<0.001) and in-hospital mortality (32% vs 24%; −0.11 95% CI− 0.15 to −0.07, p<0.001). However, external factors such as the opening of a dedicated trauma center at one intervention hospital and the COVID−19 pandemic may have influenced these results. Conclusion: Implementing a trauma quality improvement program using audit filters may reduce mortality. More research is needed to confirm these findings across different settings and to understand what makes these programs efficient, useful and sustainable in terms of improving outcomes. Trial registration: Trauma Audit Filter Trial, ClinicalTrials.gov IDNCT03235388, https://clinicaltrials.gov/study/NCT03235388

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Developing Trauma Audit Filters for Regional Referral Hospitals in Cameroon: Mixed-Methods Approach

Cited by 5 publications

References 22 publications

Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries

Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries

Contribuições da auditoria na gestão hospitalar: revisão integrativa

Effects of trauma quality improvement program implementation on mortality: A multi-center controlled interrupted time-series study

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