Determinants of adherence to tube thoracostomy protocol in chest trauma management at Mulago National Referral Hospital: a cross sectional study

Abstract

Introduction and background: High complication rates and morbidity following procedures in trauma patients have been associated with insufficient compliance with standard guidelines/ protocols. Globally, studies have documented inadequate adherence to protocols. The factors implicated to influence protocol adherence are categorized as characteristics related to the patient, professional/health worker, organization/ environment, and the protocol itself. General objective: The main purpose of this study was to assess the determinants of adherence to tube thoracostomy protocol in chest trauma management in MNRH. Methodology: The study was an institutional-based cross sectional study conducted at MNRH A&E unit and CTS ward in a 4 months’ period. 70 study patient participants with chest trauma, 16 health workers who performed tube thoracostomy and 5 health worker key informants were included. Both quantitative and qualitative data was collected. Protocol checklist, health worker questionnaire, key informant interview guide and data abstraction tool were used as data collection tools. Quantitative data will be analyzed using SPSS software with univariate, bivariate and multivartate analysis. Qualitative data will be analyzed using content analysis. Results: In the 70 patients enrolled, 90% were male and the mean age was 30.6 ±10.2 years. Pneumothorax was the commonest indication for chest tube insertion with 28 (40%) patients and most of the chest tubes were inserted during day shift. Overall adherence to the tube thoracostomy protocol was in 44% of patients. Draping of the site and attachment of a pulse oximeter on the patient were complied with the least (1.4%). Working shift was found to be statistically significant in influencing adherence, p=0.014 (p<0.05). Other factors were performance of the procedure by a lower level cadre, insufficient knowledge, unavailability of materials to use and inconsistence of consultant availability. Conclusion: This study found a high level of protocol non-adherence (in 56% of patients) which was mostly in draping of the site and attachment of a pulse oximeter on the patient. This level was mainly determined by performance of the procedure at night, in addition to performance of the procedure by a lower level cadre, insufficient knowledge, unavailability of materials to use, and inconsistence of consultant availability.