Facilitators and barriers impacting in-hospital Trauma Quality Improvement Program (TQIP) implementation: A scoping review on the implementation of TQIPs across income levels

Abstract

Abstract Background Trauma describes physical injury along with the bodies associate reponse, and is a leading cause of mortality and morbidity globally, with low and middle income countries (LMICs) disproportionately affected. Understanding the implementation of in-hospital Trauma Quality Improvement Programs (TQIPs) and the factors determining success is critical to reduce the global trauma burden. The purpose of the review was to identify key facilitators and barriers to TQIP implementation across income levels by evaluating the range of literature on the topic. Methods We used information sources PubMed, Web of Science, and Global Index Medicus. The eligibility criteria was English language studies, of any design, published from June 2009 - January 2022. The Preferred Reporting Items of Systematic Reviews and Meta-Analyses checklist extension for scoping reviews were used to carry out a three-stage screening process. Content analysis using the Consolidated Framework for Implementation Research (CFIR) identified facilitator and barrier themes for in-hospital TQIP implementation. Results Twenty-eight studies met the eligibility criteria from 3923 studies. The main facilitators and barriers identified were the need to prioritise staff education and training, strengthen dialogue with stakeholders, and provide standardised best-practice guidelines. Data quality improvements were more apparent in LMICs while high-income countries (HICs) emphasised increased communication training. Conclusions Stakeholder prioritisation of in-hospital TQIPs, along with increased knowledge and consensus on trauma care best practice will further advance efforts to lower the global trauma burden. The focus of future in-hospital TQIPs in LMICs should primarily be concerned with improving data quality of registries, while interventions in HICs should focus on communication skills of healthcare professionals.