Abstract
Background
Trauma represents a challenge to healthcare systems worldwide, particularly in low-and middle-income countries. Positive effects can be achieved by improving trauma care at the scene of the accident and throughout hospitalization and rehabilitation. Therefore, we assessed the long-term effects of national implementation of a training program for multidisciplinary trauma teams in a southern African country.
Methods
From 2007 to 2009, an educational program for trauma, “Better and Systematic Team Training,” (BEST) was implemented at all government hospitals in Botswana. The effects were assessed through interviews, a structured questionnaire, and physical inspections using the World Health Organization’s “Guidelines for Essential Trauma Care.” Data on human and physical resources, infrastructure, trauma administrative functions, and quality-improvement activities before and at 2-year follow-up were compared for all 27 government hospitals.
Results
A majority of hospitals had formed local trauma organizations; half were performing multidisciplinary trauma simulations and some had organized multidisciplinary trauma teams with alarm criteria. A number of hospitals had developed local trauma guidelines and local trauma registries. More equipment for advanced airway management and stiff cervical collars were available after 2 years. There were also improvements in the skills necessary for airway and breathing management. The most changes were seen in the northern region of Botswana.
Conclusions
Implementation of BEST in Botswana hospitals was associated with several positive changes at 2-year follow-up, particularly for trauma administrative functions and quality-improvement activities. The effects on obtaining technical equipment and skills were moderate and related mostly to airway and breathing management.
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Acknowledgments
The Laerdal Foundation for Acute Medicine provided financial support for this project.
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Appendix: Definitions
Appendix: Definitions
Trauma guidelines: Guidelines that define the trauma patient, local trauma care structure, activation criteria for trauma teams, roles for team members, qualifications for team leader, available resources, and transfer policies.
Trauma manual Written in-hospital practice, guidelines for initial triage, assessment, and treatment of injuries aimed at standardizing care given to trauma victims.
Trauma committee Organizational structure aimed at developing and implementing trauma care strategies at the individual hospital.
Trauma registry Separate local registry for trauma cases, regardless of whether they are adjusted for severity.
System for trauma audit System for identifying cases of preventable trauma deaths or suboptimal care, designing corrective plans, and monitoring the process.
Plan for trauma education Trauma-specific systematic educational efforts.
Trauma simulations Team organization and training activities in the emergency room using simulations.
Posters in the trauma room Posters on the wall in the emergency room guiding systematic trauma care.
Defined trauma team Team organization with preassigned roles and adapted to local resources.
Alarm criteria Predefined criteria (e.g., trauma mechanism, physiologic status, and anatomic injuries) that activate a team response.
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Hanche-Olsen, T.P., Alemu, L., Viste, A. et al. Evaluation of Training Program for Surgical Trauma Teams in Botswana. World J Surg 39, 658–668 (2015). https://doi.org/10.1007/s00268-014-2873-8
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DOI: https://doi.org/10.1007/s00268-014-2873-8