Trauma Registry and Trauma System Improvement Project (TSIP)

 

Bangladesh is currently undergoing an epidemic of road traffic accidents (RTAs) and hardly a day passes without a report of such an incident in the media. The latest Global Status Report on Road Safety registered some improvements for Bangladesh concerning safer roads and mobility and safer vehicles but poor performance in areas like gathering accident data, safer road users and post-crash care. A recent Rapid Review found the near absence of pre-hospital care and poor hospital-based care for the victims of the Road Traffic Crashes (RTC) which needs to be addressed urgently if we are to reduce morbidity and mortality from the RTAs.

The importance of Trauma Registry ("a collection of data on the incidence, diagnosis, and treatment of trauma victims that (should) drive a performance improvement program for the care of an injured patient,") for improving trauma care from RTIs and reduce mortality and morbidity, especially in the LMICs cannot be overemphasised. The trauma registry has been an invaluable tool for informing the design of quality trauma care system including planned allocation of resources and injury surveillance over time. However, its implementation in the LMICs face many barriers and challenges, the solutions of which need to be contextualised to the particular situation of a country. The commonly identified barriers include: data quality including missing data, lack of resources, insufficient pre-hospital care, and difficulty with administrative duties and hospital organisation. A Trauma System Improvement Programme (TSIP) informed by a Trauma Registry, and which builds on the existing emergency services, has a better chance of success due to buy-in from the relevant stakeholders, incremental changes that are acceptable and less costly, and contextualised to the real-life situation of the country in question. There are many models of TSIPs in the LMICs but all have some common components: systematic needs assessment involving relevant stakeholders, co-ordination of different components, and corrective actions to address system weaknesses to improve current system.

The World Bank, in collaboration with the MoHFW/GoB, funded to study the feasibility of introducing trauma registry and trauma systems improvement program (under its Bangladesh Road Safety Project) in four district hospitals to help reduce the morbidity and mortality from RTIs across Bangladesh. BRAC JPG School of Public Health is entrusted with execution of the one-year project and come up with recommendations for its scaling up throughout the country.

 The feasibility study aims to address the following research questions:

·         Is a trauma registry combined with post-crash TSIP feasible in high RTI burden district hospitals of Bangladesh?

·         Are TSIP audit filters useful and reliable tools for identifying specific care processes to be addressed in a post-crash care quality improvement program?

The study will adopt the World Health Organisation (WHO) Injury surveillance framework  to design and develop Trauma registries and TSIP that will provide the foundation for evidence-based and sustainable post-crash care improvements.

This cross-sectional, interdisciplinary research project comprises of feasibility assessments of TR and develop TSIP by engaging relevant stakeholders towards a sustainable data system of RTIs in the country. The field activities will be conducted in phases through integrated work packages to address specific objectives. Four district and medical college hospitals with high RTI burden, namely Comilla, Tangail, Bogra and Jhenaidah are pre-selected by the Planning Wing of MOHFW. This is a one-year project and the findigs are expected after first half of 2022.

_Excerpts from a forthcoming WB funded TR and TSIP project.