title: The design, construction and implementation of a computerised trauma registry in a developing South African metropolitan trauma service.
abstract: BACKGROUND
  The Pietermaritzburg Metropolitan Trauma Service formerly lacked a robust computerised trauma registry. This made surgical audit difficult for the purpose of quality of care improvement and development. We aimed to design, construct and implement a computerised trauma registry within our service. Twelve months following its implementation, we sought to examine and report on the quality of the registry.
  
  
  METHODS
  Formal ethical approval to maintain a computerised trauma registry was obtained prior to undertaking any design and development. Appropriate commercial software was sourced to develop this project. The registry was designed as a flat file. A flat file is a plain text or mixed text and binary file which usually contains one record per line or physical record. Thereafter the registry file was launched onto a secure server. This provided the benefits of access security and automated backups. Registry training was provided to clients by the developer. The exercise of data capture was then integrated into the process of service delivery, taking place at the endpoint of patient care (discharge, transfer or death). Twelve months following its implementation, the compliance rates of data entry were measured.
  
  
  RESULTS
  The developer of this project managed to design, construct and implement an electronic trauma registry into the service. Twelve months following its implementation the data were extracted and audited to assess the quality. A total of 2640 patient entries were captured onto the registry. Compliance rates were in the order of eighty percent and client satisfaction rates were high. A number of deficits were identified. These included the omission of weekend discharges and underreporting of deaths.
  
  
  CONCLUSIONS
  The construction and implementation of the computerised trauma registry was the beginning of an endeavour to continue improvements in the quality of care within our service. The registry provided a reliable audit at twelve months post implementation. Deficits and limitations were identified and new strategies have been planned to overcome these problems and integrate the trauma registry into the process of clinical care.
authors.affiliation: Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg Metropolitan Hospital Complex, Department of General Surgery, University of KwaZulu-Natal Nelson R Mandela School of Medicine, South Africa. Electronic address: grantlaing@me.com.
authors.forename: G L
authors.initials: GL
authors.lastname: Laing
authors.forename: J L
authors.initials: JL
authors.lastname: Bruce
authors.forename: C
authors.initials: C
authors.lastname: Aldous
authors.forename: D L
authors.initials: DL
authors.lastname: Clarke
mesh_terms: D054869:Clinical Audit; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000458:organization & administration*; D066275:Health Information Exchange / Q000706:statistics & numerical data; D006284:Health Plan Implementation / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D016730:Program Development; D058996:Quality Improvement; D012042:Registries; D013019:South Africa; D014193:Trauma Centers / Q000458:organization & administration*; D014505:Urban Population; D014947:Wounds and Injuries
keywords: Compliance; Developing world; Human factors; Trauma registry