Emergency Trauma Care in a Tertiary Centre in Lagos: A Clinical Audit

Abstract

Background: Identifying the aetiology of suboptimal care is an integral part of performance improvement, and essentially as suboptimal care has been noted to be a cause of preventable mortality and morbidity.
Methods: Using a questionnaire, data was obtained from 101 consecutive multiply injured patients seen at the National Orthopedic Hospital Lagos (NOHL). Parameters of structure and process of care as well as injury severity were obtained. Outcome was measured by trauma injury severity score (TRISS) methodology, and casualty ward length of stay (LOS). Analysis was done with SPSS for windows 11.
Results: Trauma resuscitation times averaged 112.73min. Trauma resuscitation time wasprolonged in 51.5% of cases and mortality was more likely the longer the TRT (p = 0.044). Care was adjudged inadequate in 39.60% of cases. Bivariate analyses showed that delay in haematological intervention (blood transfusion) and error in treatment, were most strongly associated statistically (p-value 0.051 and 0.006 respectively) and clinically (odds ratio 3 and 5 respectively) with mortality. Unexpected death was 60%. The mean length of stay (LOS) in casualty was 106.85hr.
Conclusion: There were deficiencies in the structure and process of trauma care that resulted in less than optimal care of the injured. Mortality and unexpected deaths by the TRISS methodology were used as outcome measures and NOHL faired rather poorly. The standardized mortality ratio >1 confirmed NOHL to be a low-quality performance hospital.


Keywords: Injury, trauma care, quality, performance improvement

Journal of College of Medicine Vol. 13 (2) 2008: pp. 65-70