Developing a Trauma System Improvement Program (TSIP) in Bangladesh: findings from a pilot study

The Trauma System Improvement Program (TSIP) plays a crucial role in improving trauma care outcomes. Despite its importance, the development and implementation of a hospital-based TSIP for road traffic injury (RTI) victims has received limited attention in Bangladesh. This pilot study explored whether a TSIP could be implemented within Bangladeshi hospitals by utilising a hospital-based Trauma Registry (TR) system. This cross-sectional, quantitative study was conducted across four public hospitals situated along national highways, areas known for high RTI prevalence. Data extracted from the hospital-based TR was used for the study. The fatal cases were analysed to understand the circumstances leading to death, what went wrong, and to evaluate how these might have been mitigated through TSIP interventions. Key TSIP components included mortality and morbidity (M&M) conferences involving relevant clinical staff, regular meetings of a steering committee (SC) overseeing the program, and training sessions for the trauma care team using existing resources. During the study period, 7,507 RTI patients were recorded in the registry. Of these, approximately 71% required admission from the emergency department (ED) to inpatient units. A total of 38 deaths (0.5%) were documented in ED and inpatient department. Following the TSIP implementation guided by TR data, documentation of vital signs and Glasgow Coma Scale (GCS) scores improved by 13%, and a 0.5% reduction in mortality was observed. Nonetheless, several challenges were encountered, including the complexity of the case report form, incomplete data entries, inconsistent adherence to trauma protocols, staff shortages resulting in excessive workload burdens, and limited institutional commitment due to heavy clinical and administrative workload. The study demonstrates that developing and operationalising a TSIP based on TR data is feasible in Bangladesh. By leveraging existing infrastructure and available resources, meaningful advancement can be made in strengthening trauma care practices.