Electronic health records (EHRs) have
become standard practice throughout hospitals in North America, but in
countries with fewer resources many front-line clinicians are still collecting
data on paper, if they are collecting it at all.
But now, surgeons from Vancouver, British
Columbia, have developed a way for their peers at a Level 1 trauma centre in
South Africa to accurately collect and analyse trauma care data via an iPad
app. The study was published in the January issue of the Journal of the American
College of Surgeons.
Traumatic injuries are among the world’s
top public health problems. Each minute, at least nine people die from an
accidental or violent injury, reports the US Centres for Disease Control and
Prevention, and 90% of trauma deaths occur in low- and middle-income countries
where injury surveillance is not accurately performed.
worsens traumatic brain injury
Moreover, the global medical community has
been more focused on infectious diseases, even though traumatic injuries
account for more deaths than HIV, tuberculosis and malaria combined, according
to Morad Hameed, MD, MPH, FACS, FRCSC, associate professor of surgery and
critical care medicine at the University of British Columbia, and a trauma
surgeon at Vancouver General Hospital.
“People think injuries are accidents, and
nothing can be done,” Dr Hameed said, “but most injuries are preventable. With
the right data and the right health care standards you can make a favourable
Access to the right data starts with having
the right tools. Groote Schuur Hospital in Cape Town, South Africa, provides superb
clinical care to the 10 000 patients seeking trauma services each year, Dr
Hameed said, but they were collecting admissions data on paper. No data were
being collected on procedures and patient outcomes.
steps were taken?
The first step for Dr Hameed and his team
was to help redesign Groote Schuur Hospital’s one-page patient admission
record. Although the information would still be captured on paper, the new
electronic Trauma Health Record (eTHR), included fields about injury
prevention, procedures, and quality of care.
It also included a carbon copy that could be torn off the back and sent
to the hospital’s data collection office.
A year later, when Dr Hameed and his team
returned to Cape Town in 2011, the Groote Schuur surgeons had collected 10 000
admissions records, a full year’s worth of patient data.
“We knew the new forms worked, but a
shortcoming was that it took three months for a grad school student to
transcribe all the forms into the database,” he said.
In 2012, Dr Hameed and his team worked with
an advisory group of trauma clinicians, data ethnographers, and medical
software designers to convert the form into an iPad app.
The goal was to ensure that completing the
iPad record did not impede clinical workflow and integrated other helpful
elements such as safety checklists, evidence-based guidelines, and the ability
to easily print, download, and upload the record to a clinical database.
The iPad record captured important
information that could be used for later analysis, such as past medical
history, residence, demographics, the cause of the injury, the injury severity
score, and the patients’ drug and alcohol use.
Instead of using the full-sized iPad,
Groote Schuur surgeons opted for the iPad mini, which could fit in their lab
coat pockets and reduce the risk of theft.
After usability testing, the Groote Schuur
Hospital surgeons used the iPad app to capture admissions data for 50 patients
who came to the hospital during June 2013 for trauma care for conditions that
included limbs that required amputations; gunshot wounds to the head, neck,
chest or abdomen; facial burns; and traumatic cardiac arrest.
Dr Hameed said it took surgeons about 10 to
12 minutes to complete the iPad record, versus 10 minutes or less on paper.
Surgeons were then able to upload the data
to a server that created a trauma patient registry. “Even though it takes as
long or slightly longer on an iPad, the database is very clean and doesn’t require
a lot of data cleanup,” Dr Hameed said.
Afterwards, Dr Hameed’s team and the Groote
Schuur surgeons were able to analyse the data to look for patterns. The data
showed that injuries were concentrated in lower income areas and most of the
causes of injury were intentional. The
predominant injury population was young males. “Of course you know that if
you’re there,” he said, “but now you can quantify it.”
Quantifying such data is what can lead to
policy interventions, such as determining which highway intersections need
traffic lights and which populations should be the target audience for injury
The iPad patient record is now standard
practice at Groote Schuur. It has been expanded to include an operations record
on which procedures patients receive, and in January 2014, it is being expanded
to include a surgical outcomes record.
After this eTHR study won the first-place
award for clinical research at the 2013 American College of Surgeons Committee
on Trauma meeting, peer surgeons have begun asking Dr Hameed and his team about
other uses for the iPad patient record.