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World Journal of Surgery

, Volume 38, Issue 7, pp 1707–1712 | Cite as

Minimizing Preventable Trauma Deaths in a Limited-Resource Setting: A Test-Case of a Multidisciplinary Panel Review Approach at the Komfo Anokye Teaching Hospital in Ghana

  • Dominic Yeboah
  • Charles Mock
  • Patrick Karikari
  • Peter Agyei-Baffour
  • Peter Donkor
  • Beth Ebel
Article

Abstract

Objective

Our objectives were to determine the proportion of preventable trauma deaths at a large trauma hospital in Kumasi, Ghana, and to identify opportunities for the improvement of trauma care.

Methods

A multidisciplinary panel of experts evaluated pre-hospital, hospital, and postmortem data of consecutive trauma patients who died over a 5-month period in 2006–2007 at the Komfo Anokye Teaching Hospital. The panel judged the preventability of each death. For preventable and potentially preventable deaths, deficiencies in care that contributed to their deaths were identified.

Results

The panel reviewed 231 trauma deaths. Of these, 84 charts had sufficient information to review preventable factors. The panel determined that 23 % of trauma deaths were definitely preventable, 37 % were potentially preventable, and 40 % were not preventable. One main deficiency in care was identified for each of the 50 definitely preventable and potentially preventable deaths. The most common deficiencies were pre-hospital delays (44 % of the 50 deficiencies), delay in treatment (32 %), and inadequate fluid resuscitation (22 %). Among the 19 definitely preventable deaths, the most common cause of death was hemorrhage (47 %), and the most common deficiencies were inadequate fluid resuscitation (37 % of deficiencies in this group) and pre-hospital delay (37 %).

Conclusions

A high proportion of trauma fatalities might have been preventable by decreasing pre-hospital delays, adequate resuscitation in hospital, and earlier initiation of care, including definitive surgical management. The study also showed that preventable death panel reviews are a feasible and useful quality improvement method in the study setting.

Keywords

Emergency Medical Service Trauma Care Preventable Death Trauma Death Quality Improvement Method 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This study was funded by a Grant (D43-TW007267) from the Fogarty International Center of the US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Dominic Yeboah
    • 1
    • 4
  • Charles Mock
    • 3
  • Patrick Karikari
    • 1
    • 2
  • Peter Agyei-Baffour
    • 1
  • Peter Donkor
    • 1
    • 2
  • Beth Ebel
    • 3
  1. 1.Kwame Nkrumah University of Science and TechnologyKumasiGhana
  2. 2.Komfo Anokye Teaching HospitalKumasiGhana
  3. 3.Harborview Injury Prevention and Research CenterUniversity of WashingtonSeattleUSA
  4. 4.Department of Surgery (Orthopaedics and Trauma)Komfo Anokye Teaching HospitalKumasiGhana

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