ACS Bulletin - April 2017

continued on next page

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.

| 15

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

REFERENCES

1. Rose J, Chang DC, Weiser TG, Kassebaum NJ, Bickler SW. The role of surgery in global health: Analysis of United States inpatient procedure frequency by condition using the global burden of disease 2010 framework. PLoS One.

2014; 9( 2):e89693.

2. Meara JG, Leather AJM, Hagander L, et al.

Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;6736(15): 1-56.

3. The World Bank. World development indicators.

Available at: data.worldbank.org/data-catalog/ world-development-indicators. Accessed February 17, 2017.

4. World Health Organization. Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage Report by the Secretariat. May 16, 2014.

Available at: apps.who.int/gb/ebwha/pdf_files/ EB135/B135_3-en.pdf. Accessed February 17, 2017.

5. World Health Organization. Department of Violence and Injury Prevention and Disability. Injuries and Violence: The Facts. 2010. Available at: apps.who.int/iris/ bitstream/10665/44288/1/9789241599375_eng. pdf. Accessed February 17, 2017.

6. Ng-Kamstra JS, Greenberg SLM, Abdullah F, et al. Global Surgery 2030: A roadmap for high income country actors. BMJ Glob Heal.

2016; 1( 1): 1-12.

7. Riviello R, Ozgediz D, Hsia RY, Azzie G, Newton M, Tarpley J. Role of collaborative academic partnerships in surgical training, education, and provision. World J Surg.

2010; 34( 3):459-465.

8. Peck GL, Paula F, Hanna J, et al. Can we augment the U.S. trauma fellow’s operative training? The PTS fellowship: A U.S. surgical critical care fellow’s experience in Colombia.