Process organization and administration

In addition to assuring adequate supplies, improved administration could also assist in appropriate utilization. In a study in Ghana, it was found that, even at an urban teaching hospital, there were significant problems with the process of trauma care. There were prolonged times to emergency surgery, with a mean time of 12 hours between arrival at the casualty ward and start of the procedure. There was also low utilization of chest tubes, even though they were physically available in the hospital. Only 0.6% of all trauma admissions had a chest tube inserted, in comparison with 6.3% at a hospital in a developed country. In addition to addressing such items individually, this study identified the implementation of basic quality improvement programmes (medical audit) as a possible way of addressing many such problems in the process of trauma care simultaneously (16).

The Essential Trauma Care Project is viewed as a way of comprehensively addressing such difficulties and deficiencies. Any such effort must build on existing foundations, which are considered next.

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