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Background: Ghana is a developing country that has strategically invested in expanding emergency care services as a means of improving national health outcomes., Objectives: Here we present Ghana as a case study for investing in emergency care to achieve public health benefits that fuel for national development., Discussion: Ghana's health leadership has affirmed emergency care as a necessary adjunct to its preexisting primary health care model. Historically, developing countries prioritize primary care efforts and outpatient clinic-based health care models. Ghana has added emergency medicine infrastructure to its health care system in an effort to address the ongoing shift in disease epidemiology as the population urbanizes, mobilizes, and ages. Ghana's investments include prehospital care, personnel training, health care resource provision, communication improvements, transportation services, and new health facilities. This is in addition to re-educating frontline health care providers and developing infrastructure for specialist training. Change was fueled by public support, partnerships between international organizations and domestic stakeholders, and several individual champions., Conclusion: Emergency medicine as a horizontal component of low- to middle-income countries' health systems may fuel national health and economic development. Ghana's experience may serve as a model., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly., Methods: Consensus on trauma care audit filters was built between twenty panellists using a Delphi technique with four anonymous, iterative surveys designed to elicit: (i) trauma care processes to be measured; (ii) important features of audit filters for the district-level hospital setting; and (iii) potentially useful filters. Filters were ranked on a scale from 0 to 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8., Results: Panellists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1--0.58; Round 2--0.66; Round 3--0.76; and Round 4--0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage--vital signs are recorded within 15 min of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation--a large bore IV was placed within 15 min of patient arrival; referral--if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer., Conclusion: This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs, the collection and reporting of prospective trauma care audit filters may be an important step towards improving care for the injured at district-level hospitals in LMICs., (Copyright © 2015 Elsevier Ltd. All rights reserved.)