An Invited Commentary on “Implementation of the WHO Trauma Care Checklist a qualitative analysis of facilitators and barriers to use”

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Akay T., Leblebici İ. M.

International Journal of Surgery, cilt.84, ss.181, 2020 (SCI Expanded İndekslerine Giren Dergi)

  • Cilt numarası: 84
  • Basım Tarihi: 2020
  • Doi Numarası: 10.1016/j.ijsu.2020.11.018
  • Dergi Adı: International Journal of Surgery
  • Sayfa Sayıları: ss.181


Application of the checklist has been associated with improved pa-tient outcomes in a variety of healthcare settings. Similarly, the WHO Trauma Care Checklist (TCC), designed to reinforce key components of emergency trauma care, has been shown to improve care process mea-sures. Despite the  potential of  checklists to  improve care, numerous barriers to  checklist use  have been identified [1].  It  is  necessary to identify the barriers and facilitators to the use of TCC in order to un-derstand what modifications may be required for the intervention to have maximum effectiveness. Willassen et al. in their study; citing characteristics such as adher-ence to protocols, documentation practices, and an advocacy culture for patient safety, they published that nurses were eligible to  take re-sponsibility for TCC implementation. Despite this, several participants from low- and middle-income countries (LMICs) considered a  high ranking physician (eg, senior physician, trauma surgeon) the  most suitable leader of TCC use [2]. The provider’s  familiarity with Advanced Trauma Life Support (ATLS) and the  basic principles of  trauma management have been identified as  both facilitators and prerequisites for  successful TCC recruitment, as the checklist is designed to begin “right after the primary and secondary questionnaires” outlined by the ATLS [3]. However, it is thought that TCC will gain more acceptance if it is formally integrated with trauma certification courses compared to  establishing it  as  a stand-alone tool. It has led to the perception by a HIC site that TCC is an effective patient care tool. Although participants felt that TCC might be most recommended in the setting of critically injured patients or mass casu-alties (MCIs), it hampered effective application [4]. Using TCC in a wide variety of ways on sites of all economic categories is an important factor. While HIC sites thought TCC added minimal schedules to existing documentation practices, participants from LMICs highlighted the challenges associated with the lack of specialist training in trauma sur-gery and  emergency medicine resulting from a  lack of  incentives to pursue a career [5]. These barriers suggest that checklists can only be meaningful tools when embedded in robust surgical systems. This study demonstrated that TCC’s formal integration with trauma courses such as ATLS, standardized TCC training as part of staff orien-tations, and improving access to trauma certification courses can be beneficial in developing standardized mechanisms. ‘Provenance and peer review Invited Commentary, internally reviewed’.