Assessment and reassessment of injured patients at non-tertiary hospitals in
Ghana: A stepped-wedge cluster randomized trial
Dublin Core
Title
Assessment and reassessment of injured patients at non-tertiary hospitals in
Ghana: A stepped-wedge cluster randomized trial
Ghana: A stepped-wedge cluster randomized trial
Subject
Trauma
Injury
Emergency care
Checklist
Reassessment
Injury
Emergency care
Checklist
Reassessment
Description
Introduction: Frequent reassessment of injured patients is an important component of trauma and emergency
care. How frequently such reassessment is done in African hospitals has been minimally addressed. We sought to
address this gap, as well as to assess the effectiveness of a standardized trauma intake form (TIF) to improve
assessment and reassessment rates.
Methods: We undertook a stepped-wedge cluster randomized trial with research assistants observing trauma care
before and after introducing the TIF at emergency units of eight non-tertiary Ghanaian hospitals for 17.5 months.
Differences in seven key performance indicators (KPIs) of assessment and reassessment were evaluated using
generalized linear mixed regression. KPIs included: respiratory rate, heart rate, blood pressure, level of consciousness, mobility, temperature, and oxygen saturation.
Results: Management of 4077 patients was observed: 2067 before TIF initiation and 2010 after. In the before
period, completion of KPIs of initial assessment ranged from 55% (oxygen saturation) to 88% (level of consciousness). KPIs for reassessment for patients still in the EU after 30 min (n = 1945, in before period) were much
lower than for initial assessment, ranging from 10% (respiratory rate and oxygen saturation) to 13% (level of
consciousness). The TIF did not significantly improve performance of any KPI of assessment or reassessment.
Similar patterns pertained for the subgroup of seriously injured patients (Injury Severity Score ≥9).
Conclusion: At non-tertiary hospitals in Ghana, performance of KPIs of initial assessment were mostly adequate,
but with room for improvement. Performance of KPIs for reassessment were very low, even for seriously injured
patients. The intervention (trauma intake form) did not impact reassessment rates, despite previously having
been shown to impact many other KPIs of trauma care. Potential avenues to pursue to improve reassessment rates
include other quality improvement efforts and increased emphasis on reassessment in training courses.
care. How frequently such reassessment is done in African hospitals has been minimally addressed. We sought to
address this gap, as well as to assess the effectiveness of a standardized trauma intake form (TIF) to improve
assessment and reassessment rates.
Methods: We undertook a stepped-wedge cluster randomized trial with research assistants observing trauma care
before and after introducing the TIF at emergency units of eight non-tertiary Ghanaian hospitals for 17.5 months.
Differences in seven key performance indicators (KPIs) of assessment and reassessment were evaluated using
generalized linear mixed regression. KPIs included: respiratory rate, heart rate, blood pressure, level of consciousness, mobility, temperature, and oxygen saturation.
Results: Management of 4077 patients was observed: 2067 before TIF initiation and 2010 after. In the before
period, completion of KPIs of initial assessment ranged from 55% (oxygen saturation) to 88% (level of consciousness). KPIs for reassessment for patients still in the EU after 30 min (n = 1945, in before period) were much
lower than for initial assessment, ranging from 10% (respiratory rate and oxygen saturation) to 13% (level of
consciousness). The TIF did not significantly improve performance of any KPI of assessment or reassessment.
Similar patterns pertained for the subgroup of seriously injured patients (Injury Severity Score ≥9).
Conclusion: At non-tertiary hospitals in Ghana, performance of KPIs of initial assessment were mostly adequate,
but with room for improvement. Performance of KPIs for reassessment were very low, even for seriously injured
patients. The intervention (trauma intake form) did not impact reassessment rates, despite previously having
been shown to impact many other KPIs of trauma care. Potential avenues to pursue to improve reassessment rates
include other quality improvement efforts and increased emphasis on reassessment in training courses.
Creator
Adam Gyedu a,b,*
, Adamu Issaka c
, Peter Donkor a
, Charles Mock d
, Adamu Issaka c
, Peter Donkor a
, Charles Mock d
Source
https://pdf.sciencedirectassets.com/280685/1-s2.0-S2211419X24X00026/1-s2.0-S2211419X24000168/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjELn%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJHMEUCIBbq3Nx4QsyEeQak0kLP65%2BE1HGZx%2F%2FzDrtLmxayJTDJAiEAsyDUr4hLk2hvc9saexM5k7xZ3j6TQMTQnLkKmYLoDBMqvAUIof%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FARAFGgwwNTkwMDM1NDY4NjUiDKn3ZY3Lwq2Xct1R2iqQBT3XyOMl%2F9l%2BUrPzj0h%2Fj8kFlwXuCyizFQjb04eiPbLe30FIGULroNYbaEROJurBeq9UEf%2FkyGYuzyItVy9C5dGjVtGJnJUJWc3Ev0AXHR%2BQ1ckF%2BldhLELHRkjmf8%2FtazTJxXVfltd40yXESr1x33dsY7%2BtHGoFXrupZR9kvqpmH61Rmk6Xi9mQFMmbmuzefrNRbA8ZWV5BVfj2lkTRgbPK%2FiGeBsQqDP3QCMyLgrcR61xn4O2Alw9RdxhcoRu%2BCmqBh0ZSelhQAFyMRD87e7kqMJMrqETMLErDy0Fi20ry04AhXfWHyXddTX7u%2BBLyrOV9tZ%2B4AcSvSY88ZrLh7siOxffPjKErnTIBForVUZN1tbIK8S9qT4Cpxlj9xFuiHlXDG33341N3GgCLh%2F0FGukNsta7ma%2F36gki1IS93IJ2%2B9mmhgNm8RFFbweqRa5V7%2FYwRIY3209z4GJe8CL2RICUVfiEy8uhvW1%2FBsoiU9RzRqngyv8X6i9vdgz3PPYhFMEP0Ik%2B4fAKKtyUUQ5vVNiuWyXETfnDdGYt1IOEEqTd118oSxWgs9Di6LfecYzbpPiKqUhpMB6UPemf5Q7kFkTk19DSxPSOyxv8PE2R%2FHPSovBlYrxz1UeQqd7U76TL2Y3Mr23GJzy4Xshlws%2F7bbf7MHXL3QzRroAdAT3StC7AVJ%2BPrnDHZ2XNWSRXaALPPMDVyYkFUURGWj%2FbrMUosy7lIJ3E9y6mlVMrDWMPVeD6VbkHtKLWbxEx8FudA4q2AK%2BTvRS3v%2FWamRReODSkLII2FSbYky2%2BXn1XqMG7WLx57PqQ%2FfASGwZZE4d9OlrSMN7IWNe3lwauk5HX2g6S2YlJNDY2m%2Bjyejtgn0qLGj%2F2MOWJz8IGOrEBSmfflv2jFSAGmtC6IieVtfQn37voUGnOj8w59K5d5hszAQi%2B31qzn55bKChZfKWjhrzyvDx9bcB4DLbmYVuNPRQIi1EbW%2FOHmkOMizO2dPlna3Ee9murwemM4OaqVcWUE9xc%2BmOvQ1nJdMVAJg0QCKynBU9ZFDlAiukr3j6v1ekRYX6LiAssRCMMH7k6jtHaJnjc5wq0LqiZ%2FJkrcgRmny4BNd8AY39RZxkPfXTx0F5r&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Date=20250619T085007Z&X-Amz-SignedHeaders=host&X-Amz-Expires=300&X-Amz-Credential=ASIAQ3PHCVTYQLGI3GT2%2F20250619%2Fus-east-1%2Fs3%2Faws4_request&X-Amz-Signature=84f04d7ac3a65a63faeffb39d25c0a978e349c375992940ab7e07c1920c4c0fa&hash=f73aef41062f1c72f172a04b096fda774bb1b9a58ccb3f28aeeac0722fc1f512&host=68042c943591013ac2b2430a89b270f6af2c76d8dfd086a07176afe7c76c2c61&pii=S2211419X24000168&tid=spdf-8d8880d5-61e7-4fba-8928-5918a73c99dc&sid=00688b7b811b2744bd985b7238466a2c58a0gxrqb&type=client&tsoh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&rh=d3d3LnNjaWVuY2VkaXJlY3QuY29t&ua=13025d5356510452075706&rr=9521c6e7e9a94ab9&cc=id
Publisher
Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana b University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana c Department of Surgery, School of Medicine, University for Development Studies, Tamale, Ghana d Department of Surgery, University of Washington, Seattle, WA, United States
Date
1 may 2024
Contributor
Fajar bagus W
Format
PDF
Language
English
Type
Text
Files
Citation
Adam Gyedu a,b,*
, Adamu Issaka c
, Peter Donkor a
, Charles Mock d , “Assessment and reassessment of injured patients at non-tertiary hospitals in
Ghana: A stepped-wedge cluster randomized trial,” Repository Horizon University Indonesia, accessed June 20, 2025, https://repository.horizon.ac.id/items/show/9564.
Ghana: A stepped-wedge cluster randomized trial,” Repository Horizon University Indonesia, accessed June 20, 2025, https://repository.horizon.ac.id/items/show/9564.