Rwanda912: Use of an innovative electronic communications platform to improve pre-hospital transport of injured people in Rwanda.

Research question Can a novel electronic system, Rwanda912, which uses an ambulance Destination Decision Support Algorithm (DDSA), improve transport time of injured patients to a facility that can treat them, in two areas (urban-Kigali and rural-Musanze), in Rwanda? Background In Rwanda, injury causes substantial disability and 9% of all deaths, 47% of which occur before-hospital. Many of these injury-related deaths and disabilities would be avoidable if delays getting to hospital were reduced. Rwanda has a country-wide free ambulance system. However, inefficiencies in communication and coordination between the ambulance and facilities cause delays in getting the right patient to the right hospital at the right time. In this multidisciplinary project, involving academics, the Ministry of Health (see letter from The Honourable Minister of Health), ambulance services, and a local not-for-profit software company (Rwanda Build Program [RWBuild]), we propose to test the efficacy and implementation of a novel, award winning, electronic system, Rwanda912, to reduce delays in transport to hospital for injured patients. Methods Our primary effectiveness outcome is time from injury to arrival at an appropriate facility. Secondary outcomes are clinical or process (e.g. death, need for ITU, length of stay). We will use an Interrupted Time Series (ITS) approach to assess effectiveness of the intervention – Rwanda912. ITS is known to be a robust method to assess effectiveness in real-world situations where a randomised controlled trial cannot be done. We will study implementation outcomes using the RE-AIM QuEST framework, which combines qualitative and quantitative measures to understand the intervention s Reach, Effectiveness, Adoption, Implementation, and Maintenance. These outcomes will facilitate understanding of the reasons for the primary and secondary effectiveness outcomes and aid in the transferability of findings elsewhere. Costs, resource use, and cost-consequences will be captured. Timelines for Delivery The project will run for 56 months. The first 3 months are for set-up. Pre-intervention data collection will be complete in months 27 and 39 in Kigali and Musanze, respectively; post-intervention data collection will be complete by months 48 and 50 in Kigali and Musanze, respectively. Rwanda912 development will be finalised whilst pre-intervention data are collected. Dissemination will be ongoing, but maximal in the final 9 months. Capacity Building is central to our project; the research capacity building plan has been developed after a capacity building survey was done with partners in Rwanda. This project will also support local technical capacity building; a key theme of RWBuild. The study question was developed after extensive community and stakeholder engagement; this will continue throughout delivery and dissemination of the study, ensuring its translation to policy. Impact will come from improved patient outcomes and research capacity in Rwanda, as well as transferability to other LMICs, if successful. Involvement of multiple stakeholders will contribute to the impact of the study, ensuring that the study is delivered and disseminated in a contextually appropriate manner. Our extensive networks with policy organisations (like WHO) and regional trauma organisations, will facilitate uptake of the intervention elsewhere. Our far-reaching dissemination plan to lay-people, academics, and policy makers will ensure impact.