Project Lead(s): Eiman Zargaran
Injury causes over six million deaths annually and accounts for 15% of overall global disability.
Ninety percent of injuries occur in low-resource countries, where use of effective prevention programs or improved clinical outcomes are hindered by limited injury surveillance capabilities.
The research group sought to develop and validate use of an electronic trauma health record (eTHR) as an injury surveillance tool for use in low- and middle-income countries (LMICs).
The eTHR was designed as a cross-platform mobile application (iOS-/Android-friendly) for use by front-line trauma clinicians to capture and analyze initial assessment, resuscitation, operative and discharge data.
Data captured by the eTHR is instantly reorganized to generate printable admission records, operative notes and discharge summaries.
Data are also immediately uploaded to a concurrent electronic trauma registry, creating one of the first clinician-entered, data-driven injury surveillance systems available.
Pilot tests were conducted, with beta-testing of the eTHR’s three modules (admission records, operative notes, discharge summary) in real-life clinical situations at Groote Schuur Hospital (GSH) in Cape Town, South Africa, one of the world’s busiest trauma centres.
Clinical documentation of all trauma patients seen at GSH was then shifted from paper-based to electronic charting.
Introduction of the eTHR resulted in no workflow disruption and, when examining the times to completion of the admission records, operative notes and discharge summary, use of the eTHR was found to be a more efficient for patient documentation, compared to paper charting.
The data captured from the eTHR for injury surveillance purposes was found to be statistically superior, in terms of field completion rates and quality of data.
Where previously minimal data were collected, now over 325 pertinent public health and trauma quality improvement fields are being captured for each patient seen by the trauma service at GSH.
This has allowed for the creation of a deep trauma registry, with capabilities of not only better describing the burden of trauma in Cape Town, but also allowing for accurate identification of major risk factors for injury and improving trauma prevention initiatives.
Since the eTHR’s successful implementation, more than 10,000 patients have been prospectively entered into GSH’s electronic trauma registry and analyzed in real time.
Overall analysis of the system concluded that tablet-based medical documentation of trauma patients is possible in a busy African trauma centre, with improved quality and timeliness of injury surveillance data collection.
The project has been scaled by others and was awarded a $300,000 US research grant from the National Institute of Health (NIH), with partners at the University of Pittsburgh. This three-year project will develop injury surveillance and trauma system capacity building in Colombia, Paraguay and Guatemala.
The team has also partnered with a similar research group from McGill University that has also been awarded a Grand Challenges Canada Phase I grant for electronic injury surveillance.