Sustaining Trauma Quality Improvement in Ghana: Evidence from a Clinical Trial

In a randomized trial across eight non-tertiary hospitals in Ghana, a structured trauma quality-improvement program anchored by a standardized trauma intake form raised TIF use from roughly 80% to 100% and produced broad, sustained KPI gains. Over the study timeline, structured QI activities tracked with steady increases in process adherence and demonstrable operational improvement.

The trial enrolled 2,010 injured patients over 14 months, organized into four contiguous 3.5-month periods. It was designed to measure process endpoints—percent TIF use and achievement of 16 prespecified KPIs—rather than mortality; the magnitude and consistency of change were statistically significant and sustained across periods.

Operationally, teams used a standardized intake form with memory prompts, targeted staff engagement and training, routine monitoring with feedback loops, and simple measurement and reporting routines that fit existing workflows. These elements were introduced iteratively and collectively supported adoption in busy emergency settings.

Ongoing staff involvement and continuous monitoring coincided with maintained or increased KPI completion. In the aggregated outcomes of the randomized clinical trial, TIF use rose stepwise (≈80% → 84% → 89% → 100%) while 12 of 16 KPIs improved significantly and 15 KPIs exceeded 90% completion by the final period—evidence that engagement plus feedback supported both uptake and measurable performance gains.

The trial provides actionable operational guidance: simple, repeatable processes tied to frontline workflows drive measurable gains and are feasible with modest investment. Implementation teams can apply these measures to preserve and scale improvements in low-resource settings.

Looking ahead, practical next steps include scaling the approach across additional hospitals and linking these process gains to clinical outcomes in future evaluations; those steps will test generalizability and clinical impact. Overall, the trial shows that sustained improvements in trauma process measures are feasible with focused, modest operational investment.

Key Takeaways:

• Structured trauma QI with a standardized TIF produced a clear uptake trajectory from ~80% to 100% TIF use and broad KPI improvement.
• Simple components—standard form, staff training, routine monitoring, and feedback—drove sustainable process gains in non-tertiary hospitals.
• Scaling and subsequent evaluation should prioritize linking process improvements to patient-centered outcomes.