Mixed methods process evaluation of pilot implementation of the African Federation for Emergency Medicine trauma data project protocol in Ethiopia

Abstract

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.

Establishing injury surveillance in emergency departments in Nepal: protocol for mixed methods prospective study

“…However significant challenges exist with relying on clinical staff to collect injury data including clinical staff capacity, the quality of data, lack of resources, insufficient prehospital care, and difficulty with administrative duties and hospital organisation [27]. Such challenges can undermine the value of the data collected as evidenced through one recent, well organised study in Ethiopia which found a capture rate of just 21% for injury data on their clinical data tool [31].…”

“…A standardised data collection form has been developed drawing on a number of existing tools including the African Federation of Emergency Medicine [31], the World Health Organisation [17] and the Home and Leisure Accident and Surveillance System (HASS) from the Royal Society for the Prevention of Accidents [32], developed and adapted for the Nepal context. The data collection form will not replace existing clinical records as the existing clinical record keeping in the two study sites are not sufficiently detailed or reliable to capture the required epidemiological or clinical data on injuries.…”

The Epidemiology of Injuries in Adults in Nepal: Findings from a Hospital-Based Injury Surveillance Study

“…The injury severity was classified as ‘minor’ (superficial injury such as bruises or cuts), ‘moderate’ (injures requiring skilled treatment), or ‘severe’ (injures requiring intensive management), depending on the level of requirement for skilled emergency care intervention. A standardised data collection form was developed from existing tools [ 13 , 23 , 24 ], adapted for the Nepal context, and piloted prior to data collection. All data collection was conducted in the Nepali language.…”

Developing a research question: A research primer for low- and middle-income countries

“…Projects do not need to be expensive, reliant on large data sets or implemented across countries, although studies such as FEAST [ 24 ] and CRASH-2 [ 25 ] demonstrate that high quality and impactful quantitative research in LMICs is possible. Important and relevant EC publications using qualitative and mixed methods from Africa [ 26 , 27 ] and the Pacific region [ [28] , [29] , [30] ], for example, also illustrate that meaningful research can be locally-devised, inexpensive and single-site.…”

“…The examples provided earlier in this paper from the Pacific region, regarding trauma care in Fiji [ 30 ], asthma management in Papua New Guinea [ 28 ] and triage in the Solomon Islands [ 29 ], have all used a qualitative ‘action research’ framework to explore the implementation science, and simple quantitative methods to measure outcomes. In Africa, mixed methods have been to describe and evaluate a training program [ 26 ], and to analyse the introduction of a new process for trauma data collection [ 27 ]. These approaches are highly acceptable and have great utility in resource limited contexts; they provide rich data on the real-life experiences, outcomes and challenges involved with implementing a new intervention to improve clinical care or develop an EC system.…”