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The data suggest that trauma is one of the leading causes of
preventable death around the world and disproportionately affects
LMICs. Therefore, trauma program development may play a
crucial role in improving health and surgical systems overall.
Furthermore, a quality improvement study will make it
feasible to transfer data from independent prehospital data
systems to trauma hospital registries. This study provides
the ability to assess prehospital care as a factor in trauma outcomes and integrates prehospital with hospital data collection
in trauma registries, providing an opportunity for individual
patient and systems of care evaluation and improvement.
Certain aspects of indicator data collection proved challenging. It was difficult to locate hospital data that were consistently
collected and that accurately reflected the LCoGS indicator
being measured. For example, indicator 2 (surgical workforce
density) was conflated on both ends of the spectrum. We found
that surgeons tend to have multiple independent hospital contracts, potentially inflating reported workforce density. In
addition, other credentialed health care professionals are per-mitted to perform surgical procedures in Colombia as surgeon
assistants. As a result, the data is skewed in the opposite direction. Indicator 3 (volume of surgical procedures) was affected
by the underrecording of operations that occur outside of the
operating theater (for example, procedures that trauma or
acute care surgeons perform in the emergency room), amounting to the exclusion of approximately 40 percent of surgical
cases at an academic hospital. Furthermore, because only
public sector records were readily accessible, operations performed in the private sector were excluded.
It is also important to note that in the U.S., the trauma nurse
manager (TNM) plays a key role in trauma programs and systems (see Table 3). Our experience with domestic stakeholders
from the nursing profession and the Ministry of Health has
shown that TNMs are grossly underrepresented in Colombia. Support of nursing education and training in the region
could augment the capacity for a national trauma system while
also promoting gender-balanced leadership in the health and
surgical care workforce. The Especializacion en Enfermeria en
Trauma, Emergencia Quirurgica y Cuidado Critico del Trauma (The
Specialization of Trauma, Emergency Surgery, and Surgical
Critical Care Nursing) is an initiative in Colombia that seeks
to expand the domestic nursing leadership. Although the proliferation of TNMs would not change the value of indicator
2 under its current definition, which focuses on the physician workforce, the development of a regionally appropriate
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