Use of an innovative electronic communications platform to improve pre-hospital transport of injured people in Rwanda
| ISRCTN | ISRCTN97674565 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN97674565 |
| Secondary identifying numbers | NIHR203062 |
- Submission date
- 23/05/2024
- Registration date
- 29/07/2024
- Last edited
- 15/08/2025
- Recruitment status
- Recruiting
- Overall study status
- Ongoing
- Condition category
- Other
Plain English summary of protocol
Background and study aims
Delays in getting injured patients to the hospital on time result in avoidable death and disability. This is particularly the case in low- or middle-income countries (LMICs), where even when ambulance systems are available, communication between ambulance systems, patients, and hospitals is inefficient. In Rwanda, injury causes 9% of deaths; 47% occurring before-hospital. Similar to many LMICs, Rwanda experiences long delays in getting patients to the hospital, with all communication between patients, ambulances, and hospitals done using multiple phone calls. To overcome these difficulties, a local software firm designed Rwanda912, a novel electronic tool for use in low-resource settings. Rwanda912 uses an ambulance Destination Decision Support Algorithm (DDSA) which regularly collects information from hospitals on the availability of staff and equipment, and from the ambulance crew on patient status; it uses this information to match the patient with the nearest able hospital. It has been endorsed by the Rwandan Ministry of Health (MoH) and won local innovation awards. In collaboration with MoH, Rwandan ambulance services, and local and international academics, this project will test whether Rwanda912 reduces time from injury to arrival at the hospital and improves clinical outcomes such as death and length of stay in the hospital.
Who can participate?
All patient incidents/patient conditions transported to public health facilities by Service d’Aide Medicale Urgente (SAMU) in Rwanda
What does the study involve?
The study will ensure Rwanda912 is acceptable to users and failsafe in the field before it is deployed in ambulances and will test whether it improves patient outcomes in a major urban and rural district in Rwanda. Along with collecting information on patient outcomes after Rwanda912 is deployed, information will be collected from people who use Rwanda912 about its “user friendliness” and whether it is being used as intended. Additionally, the study will assess the costs and resources needed to develop and deploy it. These outcomes will be used to determine roll-out throughout the country by MoH and provide knowledge to enable its transferability to other countries. The study focuses on injured patients, however, if successful, the findings will apply to other emergency conditions requiring ambulance transport. Capacity building is central to the project, supporting the development of project management, research, and software development skills amongst Rwandan partners. The project will also support Rwandan PhD students to be jointly supervised by Rwandan and UK supervisors. The project development has been informed through deep engagement with key stakeholders - including patients, healthcare workers, and policymakers - on their needs and priorities around injury care. Stakeholder engagement will continue throughout the project, in project management, governance, and ensuring that the research findings have an impact. The study team plans to achieve this through a structured program, supporting and enabling community and health systems stakeholders to drive policy based on the research findings. Engagement with our international collaborators including at WHO and Emergency Medical Societies in LMICs will ensure maximal international impact.
What are the possible benefits and risks of participating?
The intervention will be delivered at the level of the health system and patients are not going to be individually enrolled.
Where is the study run from?
Murray Learning Centre, University of Birmingham (UK)
When is the study starting and how long is it expected to run for?
November 2022 to October 2027
Who is funding the study?
National Institute for Health and Care Research, (NIHR) Research and Innovation for Global Health Transformation
Who is the main contact?
Prof Justine Davies, j.davies.6@bham.ac.uk
Contact information
Scientific, Principal Investigator
Murray Learning Centre
University of Birmingham
Edgbaston
Birmingham
B15 2TT
United Kingdom
 ORCID ID |
0000-0001-6834-1838 |
|---|---|
| Phone | +44 (0) 7384 584673 |
| j.davies.6@bham.ac.uk |
Public
Murray Learning Centre
University of Birmingham
Edgbaston
Birmingham
B15 2TT
United Kingdom
| ORCID ID |
0000-0002-8019-2561 |
|---|---|
| Phone | +44 (0) 7448863640 |
| a.nishimwe.1@bham.ac.uk |
Study information
| Study design | Single-centre interventional hybrid type 2 effectiveness implementation study |
|---|---|
| Primary study design | Interventional |
| Secondary study design | Non randomised study |
| Study setting(s) | Hospital, Medical and other records, Workplace, Other |
| Study type | Prevention, Safety |
| Participant information sheet | Not available in web format, please use contact details to request a participant information sheet |
| Scientific title | Use of an innovative electronic communications platform (Rwanda912) to improve pre-hospital transport of injured people in Rwanda: a hybrid type 2 effectiveness implementation study |
| Study acronym | Rwanda912 |
| Study objectives | 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? |
| Ethics approval(s) |
Approved 10/02/2023, Rwanda National Ethics Commitee (KN 3 RD, Kicukiro, Kigali, P.O. BOX 84, Rwanda; +250 788 592 004; info@rnecrwanda.org), ref: No.99/RNEC/2023 |
| Health condition(s) or problem(s) studied | Pre-hospital care and emergency medical services |
| Intervention | The intervention consists of the implementation and evaluation of Rwanda912, an emergency medical services communication system intervention composed of interfaces to capture facility and patient-relevant data and a guideline-based destination decision support algorithm (DDSA). The intervention aims to reduce delays in transport to hospitals for injured patients. An Interrupted Time Series (ITS) approach will be used to assess the effectiveness of the intervention. Implementation outcomes will be studied using the RE-AIM QuEST framework, which combines qualitative and quantitative measures to understand the intervention's Reach, Effectiveness, Adoption, Implementation, Cost, and Maintenance. |
| Intervention type | Other |
| Primary outcome measure | Time from injury to arrival at an appropriate facility measured using data collected on individual patients' records in the Rwanda912 database and trauma registry from baseline through to end-line |
| Secondary outcome measures | 1. Clinical or process (e.g. death, need for ITU, length of stay) measured using data collected on individual patients from hospitals' electronic medical records and the trauma registry from baseline through to end-line 2. Quality of life measured using the self-assessed, health-related quality of life questionnaire (EQ5D5L) after the rollout of the intervention 3. Disability measured using the WHO Disability Assessment Schedule (WHODAS) after the rollout of the intervention 4. Implementation outcomes: Reach, Effectiveness, Adoption, Implementation, Cost, and Maintenance measured using the RE-AIM QuEST framework after the rollout of the intervention |
| Overall study start date | 01/11/2022 |
| Completion date | 31/10/2027 |
Eligibility
| Participant type(s) | Patient, Health professional, Service user |
|---|---|
| Age group | All |
| Sex | Both |
| Target number of participants | Sample size is based upon an expected number of observations each week (i.e., number of ambulances calls in each region per week) of at least 50. We have assumed a realistic auto-regressive correlation of order 1 (exponential decay) will be sufficient to characterise the correlation structure of the data. We assume a small to moderate effect size (standardised effect size of 0.25) in line with the nature of the intervention. This standardised effect size of 0.25 can be considered as a target effect size of quarter of the standard deviation of the outcome (across the monthly time periods). For example, if the average time from calling of the ambulance to arrival at facility has a mean of 70 minutes and SD 30 (across 108 weeks of the evaluation), this would be equivalent in an effect of the intervention of 7.5 minutes. A sample size of 108 observations (for example weekly means of duration of time to hospital), assuming an equal number of observations pre and post roll-out, would provide more than 90% power across all values of auto-regressive correlations (at 5% significance). This is a conservative calculation as we will have between around 100 measures pre- the official roll-out and 50 to 70 measures post roll-out; meaning our evaluation should have power to detect smaller changes than 7.5 minutes. This change represents the total change in the post roll out period and includes shift changes and trend changes. |
| Key inclusion criteria | 1. All incidents/patient conditions transported by Service d’Aide Medicale Urgente (SAMU) in Rwanda 2. For clinical outcomes, the study will concentrate on patients transported to public health facilities because they receive the largest number of cases from SAMU |
| Key exclusion criteria | Patients transported to private health facilities |
| Date of first enrolment | 01/10/2023 |
| Date of final enrolment | 01/06/2027 |
Locations
Countries of recruitment
- Rwanda
Study participating centres
Not applicable
Rwanda
Not applicable
Rwanda
Sponsor information
University/education
Edgbaston
Birmingham
B15 2TT
England
United Kingdom
| Phone | +44 (0)121 414 3344 |
|---|---|
| welcome@contacts.bham.ac.uk | |
| Website | http://www.birmingham.ac.uk/index.aspx |
"ROR" |
https://ror.org/03angcq70 |
Funders
Funder type
Government
Government organisation / National government
- Alternative name(s)
- National Institute for Health Research, NIHR Research, NIHRresearch, NIHR - National Institute for Health Research, NIHR (The National Institute for Health and Care Research), NIHR
- Location
- United Kingdom
Results and Publications
| Intention to publish date | 31/10/2028 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Available on request |
| Publication and dissemination plan | Policy dissemination: The Ministry of Health (MoH) of Rwanda and its technical arm (The Rwanda Biomedical Centre), the Rwandan Ambulance Services (“SAMU, Division of Emergency Medical Services (EMS)” including Dispatch), the Software developer, and healthcare providers at facilities are co-investigators on this project. The study team will not simply be disseminating results to them; they have been actively involved in the development of the project and will be involved in the running of the project to ensure that it is done in a manner which will maximise impact. Policy Briefs will be created for the study team or members of the Scientific Advisory Group to use in dissemination to wider audiences and funders. In addition, the study team will form community engagement groups (injured persons community groups) in Kigali and Musanze to advocate for better care for injured persons. Local dissemination will be guided by community members. Dissemination to academics: This will be via presentations at conferences, peer-reviewed publications in open-access journals, and via social media. All methodologies will be posted on our website for use by others. |
| IPD sharing plan | The anonymised data generated and/or analysed during the current study will be available upon reasonable request from Prof. Justine Davies, j.davies.6@bham.ac.uk, 12 months after the project has ended, to ensure that local academics have the opportunity to use the data for their own purposes. |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol (preprint) | 24/12/2024 | 07/01/2025 | No | No | |
| Protocol article | 27/06/2025 | 30/06/2025 | Yes | No | |
| Protocol article | 13/08/2025 | 15/08/2025 | Yes | No |
Editorial Notes
15/08/2025: Publication reference added.
30/06/2025: Publication reference added.
07/01/2025: Publication reference added.
11/09/2024: King's College London was removed as a sponsor.
24/05/2024: Study's existence confirmed by the Rwanda National Ethics Committee.
