Strengthening emergency care research quality: A commentary on a mid-study PDSA in a multisite project in Ghana

Emergency medicine is rapidly evolving across Africa, yet the field continues to face significant gaps in research quality, particularly in study design and implementation. To generate actionable evidence that reflects the acute care needs of African populations, it is critical to embed quality management measures within clinical research processes. This commentary describes the use of the Plan-Do-Study-Act (PDSA), a simple and reproducible quality improvement (QI) tool, as a mid-study quality audit strategy during the implementation of the “Pathways to Care for Patients with Acute Infectious Illnesses in Ghana” (PATHCARE) study. Over two weeks, trained evaluators conducted structured observations and interviews with research assistants (RAs) across five study sites in Kumasi, Ghana. The audit revealed protocol deviations related to patient screening, recruitment, informed consent, and data collection that threatened data integrity and participant protection. Based on these findings, a targeted refresher training was conducted, leading to measurable improvements in RA knowledge of study protocol. This experience highlights the feasibility and impact of embedding low-cost, iterative quality audits within emergency care research. Especially in resource-constrained settings with limited research infrastructure, tools like the PDSA can serve as pragmatic solutions to enhance data reliability, safeguard ethical standards, and ultimately, improve the quality and utility of clinical research in African emergency medicine.