A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited setting
Abstract Background Prehospital (ambulance) care can reduce morbidity and mortality from trauma. Yet, there is a dearth of effective evidence-based interventions and implementation strategies. Emergency Medical Services Traumatic Shock Care (EMS-TruShoC) is a novel bundle of five core evidence-based...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-12-01
|
| Series: | Pilot and Feasibility Studies |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40814-019-0536-0 |
| _version_ | 1818603747432988672 |
|---|---|
| author | Nee-Kofi Mould-Millman Julia Dixon Andrew Lamp Shaheem de Vries Brenda Beaty Lani Finck Kathryn Colborn Kubendhren Moodley Amanda Skenadore Russell E. Glasgow Edward P. Havranek Vikhyat S. Bebarta Adit A. Ginde |
| author_facet | Nee-Kofi Mould-Millman Julia Dixon Andrew Lamp Shaheem de Vries Brenda Beaty Lani Finck Kathryn Colborn Kubendhren Moodley Amanda Skenadore Russell E. Glasgow Edward P. Havranek Vikhyat S. Bebarta Adit A. Ginde |
| author_sort | Nee-Kofi Mould-Millman |
| collection | DOAJ |
| description | Abstract Background Prehospital (ambulance) care can reduce morbidity and mortality from trauma. Yet, there is a dearth of effective evidence-based interventions and implementation strategies. Emergency Medical Services Traumatic Shock Care (EMS-TruShoC) is a novel bundle of five core evidence-based trauma care interventions. High-Efficiency EMS Training (HEET) is an innovative training and sensitization program conducted during clinical shifts in ambulances. We assess the feasibility of implementing EMS-TruShoC using the HEET strategy, and feasibility of assessing implementation and clinical outcomes. Findings will inform a main trial. Methods We conducted a single-site, prospective cohort, multi-methods pilot implementation study in Western Cape EMS system of South Africa. Of the 120 providers at the study site, 12 were trainers and the remaining were eligible learners. Feasibility of implementation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Feasibility of assessing clinical outcomes was assessed using shock indices and clinical quality of care scores, collected via abstraction of patients’ prehospital trauma charts. Thresholds for progression to a main trial were developed a priori. Results The average of all implementation indices was 83% (standard deviation = 10.3). Reach of the HEET program was high, with 84% learners completing at least 75% of training modules. Comparing the proportion of learners attaining perfect scores in post- versus pre-implementation assessments, there was an 8-fold (52% vs. 6%) improvement in knowledge, 3-fold (39% vs. 12%) improvement in skills, and 2-fold (42% vs. 21%) increase in self-efficacy. Clinical outcomes data were successfully calculated—there were clinically significant improvements in shock indices and quality of prehospital trauma care in the post- versus pre-implementation phases. Adoption of HEET was good, evidenced by 83% of facilitator participation in trainings, and 100% of surveyed stakeholders indicating good programmatic fit for their organization. Stakeholders responded that HEET was a sustainable educational solution that aligned well with their organization. Implementation fidelity was very high; 90% of the HEET intervention and 77% of the implementation strategy were delivered as originally planned. Participants provided very positive feedback, and explained that on-the-job timing enhanced their participation. Maintenance was not relevant to assess in this pilot study. Conclusions We successfully implemented the EMS-TruShoC educational intervention using the HEET training strategy in a single-site pilot study conducted in a low-resource international setting. All clinical outcomes were successfully calculated. Overall, this pilot study suggests high feasibility of our future, planned experimental trial. |
| first_indexed | 2024-12-16T13:28:05Z |
| format | Article |
| id | doaj.art-2fa29b231ee94c41896d0a17e7b25dcf |
| institution | Directory Open Access Journal |
| issn | 2055-5784 |
| language | English |
| last_indexed | 2024-12-16T13:28:05Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Pilot and Feasibility Studies |
| spelling | doaj.art-2fa29b231ee94c41896d0a17e7b25dcf2022-12-21T22:30:09ZengBMCPilot and Feasibility Studies2055-57842019-12-015111310.1186/s40814-019-0536-0A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited settingNee-Kofi Mould-Millman0Julia Dixon1Andrew Lamp2Shaheem de Vries3Brenda Beaty4Lani Finck5Kathryn Colborn6Kubendhren Moodley7Amanda Skenadore8Russell E. Glasgow9Edward P. Havranek10Vikhyat S. Bebarta11Adit A. Ginde12University of Colorado, School of MedicineUniversity of Colorado, School of MedicineUniversity of Colorado, School of MedicineWestern Cape Government Health, Emergency Medical ServicesAdult and Child Consortium for Health Outcomes Research and Delivery Science, University of ColoradoUniversity of Colorado, School of MedicineDepartment of Biostatistics and Informatics, Colorado School of Public Health, University of ColoradoCollege of Emergency Care, Western Cape GovernmentAdult and Child Consortium for Health Outcomes Research and Delivery Science, University of ColoradoAdult and Child Consortium for Health Outcomes Research and Delivery Science, University of ColoradoUniversity of Colorado, School of MedicineUniversity of Colorado, School of MedicineUniversity of Colorado, School of MedicineAbstract Background Prehospital (ambulance) care can reduce morbidity and mortality from trauma. Yet, there is a dearth of effective evidence-based interventions and implementation strategies. Emergency Medical Services Traumatic Shock Care (EMS-TruShoC) is a novel bundle of five core evidence-based trauma care interventions. High-Efficiency EMS Training (HEET) is an innovative training and sensitization program conducted during clinical shifts in ambulances. We assess the feasibility of implementing EMS-TruShoC using the HEET strategy, and feasibility of assessing implementation and clinical outcomes. Findings will inform a main trial. Methods We conducted a single-site, prospective cohort, multi-methods pilot implementation study in Western Cape EMS system of South Africa. Of the 120 providers at the study site, 12 were trainers and the remaining were eligible learners. Feasibility of implementation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Feasibility of assessing clinical outcomes was assessed using shock indices and clinical quality of care scores, collected via abstraction of patients’ prehospital trauma charts. Thresholds for progression to a main trial were developed a priori. Results The average of all implementation indices was 83% (standard deviation = 10.3). Reach of the HEET program was high, with 84% learners completing at least 75% of training modules. Comparing the proportion of learners attaining perfect scores in post- versus pre-implementation assessments, there was an 8-fold (52% vs. 6%) improvement in knowledge, 3-fold (39% vs. 12%) improvement in skills, and 2-fold (42% vs. 21%) increase in self-efficacy. Clinical outcomes data were successfully calculated—there were clinically significant improvements in shock indices and quality of prehospital trauma care in the post- versus pre-implementation phases. Adoption of HEET was good, evidenced by 83% of facilitator participation in trainings, and 100% of surveyed stakeholders indicating good programmatic fit for their organization. Stakeholders responded that HEET was a sustainable educational solution that aligned well with their organization. Implementation fidelity was very high; 90% of the HEET intervention and 77% of the implementation strategy were delivered as originally planned. Participants provided very positive feedback, and explained that on-the-job timing enhanced their participation. Maintenance was not relevant to assess in this pilot study. Conclusions We successfully implemented the EMS-TruShoC educational intervention using the HEET training strategy in a single-site pilot study conducted in a low-resource international setting. All clinical outcomes were successfully calculated. Overall, this pilot study suggests high feasibility of our future, planned experimental trial.https://doi.org/10.1186/s40814-019-0536-0Pilot studyFeasibility studyImplementation scienceGlobal healthResource-limitedEducation |
| spellingShingle | Nee-Kofi Mould-Millman Julia Dixon Andrew Lamp Shaheem de Vries Brenda Beaty Lani Finck Kathryn Colborn Kubendhren Moodley Amanda Skenadore Russell E. Glasgow Edward P. Havranek Vikhyat S. Bebarta Adit A. Ginde A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited setting Pilot and Feasibility Studies Pilot study Feasibility study Implementation science Global health Resource-limited Education |
| title | A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited setting |
| title_full | A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited setting |
| title_fullStr | A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited setting |
| title_full_unstemmed | A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited setting |
| title_short | A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited setting |
| title_sort | single site pilot implementation of a novel trauma training program for prehospital providers in a resource limited setting |
| topic | Pilot study Feasibility study Implementation science Global health Resource-limited Education |
| url | https://doi.org/10.1186/s40814-019-0536-0 |
| work_keys_str_mv | AT neekofimouldmillman asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT juliadixon asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT andrewlamp asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT shaheemdevries asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT brendabeaty asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT lanifinck asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT kathryncolborn asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT kubendhrenmoodley asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT amandaskenadore asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT russelleglasgow asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT edwardphavranek asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT vikhyatsbebarta asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT aditaginde asinglesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT neekofimouldmillman singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT juliadixon singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT andrewlamp singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT shaheemdevries singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT brendabeaty singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT lanifinck singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT kathryncolborn singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT kubendhrenmoodley singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT amandaskenadore singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT russelleglasgow singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT edwardphavranek singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT vikhyatsbebarta singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting AT aditaginde singlesitepilotimplementationofanoveltraumatrainingprogramforprehospitalprovidersinaresourcelimitedsetting |