The Bolivian trauma patient's experience: A qualitative needs assessment

Rook, Jordan M.; Wood, Ethan; Boeck, Marissa A.; Blair, Kevin J.; Monroy, Alexa; Ludi, Erica; Keller, Eric J.; Victorson, David; Foíanini, Esteban; Swaroop, Mamta

doi:10.1016/j.injury.2020.12.014

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…Therefore, the use of REBOA requires multidisciplinary health personnel with training and advanced equipment. This can be a disadvantage in low to middle-income countries, and limit the applicability of these techniques [ 28 – 30 ].…”

Section: Discussionmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta in civilian pre-hospital care: a systematic review of the literature

et al. 2022

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Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a damage control tool with a potential role in the hemodynamic resuscitation of severely ill patients in the civilian pre-hospital setting. REBOA ensures blood flow to vital organs by early proximal control of the source of bleeding. However, there is no consensus on the use of REBOA in the pre-hospital setting. This article aims to perform a systematic review of the literature about the feasibility, survival, indications, complications, and potential candidates for civilian pre-hospital REBOA. Methods A literature search was conducted using Medline, EMBASE, LILACS and Web of Science databases. Primary outcome variables included overall survival and feasibility. Secondary outcome variables included complications and potential candidates for endovascular occlusion. Results The search identified 8 articles. Five studies described the use of REBOA in pre-hospital settings, reporting a total of 47 patients in whom the procedure was attempted. Pre-hospital REBOA was feasible in 68–100% of trauma patients and 100% of non-traumatic patients with cardiac arrest. Survival rates and complications varied widely. Pre-hospital REBOA requires a coordinated and integrated emergency health care system with a well-trained and equipped team. The remaining three studies performed a retrospective analysis identifying 784 potential REBOA candidates. Conclusions Pre-hospital REBOA could be a feasible intervention for a significant portion of severely ill patients in the civilian setting. However, the evidence is limited. The impact of pre-hospital REBOA should be assessed in future studies.

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Section: Discussionmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta in civilian pre-hospital care: a systematic review of the literature

et al. 2022

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“…A la fecha, existen experiencias latinoamericanas en Honduras, Ecuador, Brasil, Bolivia y Colombia sobre la conducción de registros de trauma. Es de resaltar, que estas experiencias tienen en común una proporción significativa de pacientes traumatizados a causa de agresiones físicas por violencia [11][12][13][14][15] , hallazgos que coinciden con el reporte de la Organización Panamericana de la Salud donde la región de las Américas es la región con mayor tasa de homicidios en el mundo (19,19 por cada 100.000 habitantes en 2019), valor que es tres veces mayor que el promedio global 16 .…”

Section: Introductionunclassified

De un centro de trauma a un sistema de trauma en el suroccidente colombiano

et al. 2023

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Introducción. El objetivo de este estudio fue evaluar el impacto sobre la mortalidad según el perfil de ingreso a un centro de trauma del suroccidente colombiano, como método para entender las dinámicas de atención del paciente con trauma. Métodos. Se realizó un subanálisis del registro de la Sociedad Panamericana de Trauma asociado a un centro de trauma en el suroccidente colombiano. Se analizaron los pacientes atendidos entre los años 2012 y 2021. Se compararon los pacientes con condición de ingreso directo y aquellos que ingresaron remitidos. Se hicieron análisis de poblaciones de interés como pacientes con trauma severo (ISS > 15) y pacientes con/sin trauma craneoencefálico. Se evaluó el impacto de los pacientes remitidos y su condición al ingreso sobre la mortalidad. Resultados. Se incluyeron 10.814 pacientes. La proporción de pacientes remitidos fue del 54,7 %. Los pacientes que ingresaron remitidos presentaron diferencias respecto a la severidad del trauma y compromiso fisiológico al ingreso comparado con los pacientes con ingreso directo. Los pacientes remitidos tienen mayor riesgo de mortalidad (RR: 2,81; IC95% 2,44-3,22); sin embargo, es el estado fisiológico al ingreso lo que impacta en la mortalidad. Conclusión. Los pacientes remitidos de otras instituciones tienen un mayor riesgo de mortalidad, siendo una inequidad en salud que invita a la articulación de actores institucionales en la atención de trauma. Un centro de trauma debe relacionarse con las instituciones asociadas para crear un sistema de trauma que optimice la atención de los pacientes y la oportunidad.

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“…It has been used to improve efficiency and clinical outcomes in surgery, using measures such as length of stay and peri‐operative complications [6, 8, 10, 12, 13]. However, implementation of QI initiatives in surgery remains sparse in LMICs [10, 14, 15]. Peru is facing challenges to provide surgical care as only 1969 surgical procedures per 100,000 are performed, suggesting an additional 3031 procedures per 100,000 are needed annually to address the burden of disease [16].…”

Section: Introductionmentioning

confidence: 99%

Quality Improvement to Address Surgical Burden of Disease at a Large Tertiary Public Hospital in Peru

et al. 2021

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Background In resource‐limited settings, there is a unique opportunity for using process improvement strategies to address the lack of access to surgical care. By implementing organizational changes in the surgical admission process, we aimed to decrease wait times, increase surgical volume, and improve patient satisfaction for elective general surgery procedures at a public tertiary hospital in Lima, Peru. Methods During the first phase of the intervention, Plan‐Do‐Study‐Act (PDSA) cycles were performed to ensure the surgery waitlist included up‐to‐date clinical information. In the second phase, Lean Six Sigma methodology was used to adapt the admission and scheduling process for elective general surgery patients. After six months, outcomes were compared to baseline data using Wilcoxon rank‐sum test. Results At the conclusion of phase one, 87.0% (488/561) of patients on the new waitlist had all relevant clinical data documented, improved from 13.3% (2/15) for the pre‐existing list. Time from admission to discharge for all surgeries improved from 5 to 4 days (p<0.05) after the intervention. Median wait times from admission to operation for elective surgeries were unchanged at 4 days (p=0.076) pre‐ and post‐intervention. There was a trend toward increased weekly elective surgical volume from a median of 9 to 13 cases (p=0.24) and increased patient satisfaction rates for elective surgery from 80.5 to 83.8% (p=0.62), although these were not statistically significant. Conclusion The process for scheduling and admitting elective surgical patients became more efficient after our intervention. Time from admission to discharge for all surgical patients improved significantly. Other measured outcomes improved, though not with statistical significance. Main challenges included gaining buy‐in from all participants and disruptions in surgical services from bed shortages.

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The Bolivian trauma patient's experience: A qualitative needs assessment

Cited by 4 publications

References 16 publications

Resuscitative endovascular balloon occlusion of the aorta in civilian pre-hospital care: a systematic review of the literature

Resuscitative endovascular balloon occlusion of the aorta in civilian pre-hospital care: a systematic review of the literature

De un centro de trauma a un sistema de trauma en el suroccidente colombiano

Quality Improvement to Address Surgical Burden of Disease at a Large Tertiary Public Hospital in Peru

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