• Doctors (consultants, residents, interns) do not have time to be the end user.

• Must hire support staff for data collection and to use GRYMTR.

• Decision to operate or send to ICU is not in neurosurgery team's control.

• Neurosurgery consultant has limited technology exposure.

• Current technology use is limited, however, google glass project was well-accepted.

• Surgery resident feedback was extremely positive.

• Neurosurgery support staff interested in tool.

• Capacity is exceeded throughout in-hopsital care continuum.

• Heavy resource investment needed.

• Must purchase medical equipment and hire staff to collect vitals.

• Neurosurgery only specialty with daily rounding.

• Unknown

• GRYMTR performance in Uganda unknown.

• Unaware of other intervention or technology solution currently piloted MRRH.

• GRYMTR implementation will require heavy resource investment (support staff, medical equipment, ipad).

• Unknown.

• Unknown.

• Internet connectivity is very good with a mifi device, even when power is out.
• There is no computer in hospital and not everyone has smartphone.
• There is a laptop for the neurosurgery team.
• See GRYMTR feedback document.

• Adapt GRYMTR to Uganda data.
• Begin feasibility testing 10/25.
• Hire research personnel to improve data quality of registry.
• Do we want to hire personnel to pilot app? An end user? How do we want to pilot?

• GRYMTR could be used by resident if app on phone or ER ipad purchased.

• Unknown potential to influence care decisions outside ER (e.g. ICU, OR)

• Support from leadership in emergency medicine and surgery.

• KCMC has a rich research history and frequently pilots new projects in ED.

• There is strong need to support triage practice at KCMC.

• Capacity is exceeded throughout in-hopsital care continuum.

• ED workflow is organized (at time organized chaos).

• Morning rounding occurs.

• Can hire a research assistant for support.

• Computer in ED if needed.

-Unknown.

• GRYMTR was developed and validated at KCMC.

• There is no existing precedent for decision support tools to my knowledge.

• Rounding happens every morning in ER where GRYMTR could be used.

• There are multiple residents in ED which could be end-users of GRYMTR.

• KCMC is a progressive institution.

• Unknown.

• Unknown.

• There are computers in each department.
• There is good internet connectivity with a mifi device.
• See GRYMTR feedback document.

• Submit IRB in October.
• Begin piloting in January.
• Continue conversation with surgery consultant Dr. Kondo.

• NIMHANS is flooded with patients. A doctor as GRYMTR end-user may not be possible.

• Largely unknown.

• Support from upper leadership for tool.

• Feedback from front-line staff remains unknown.

• Feedback from upper leadership was positive.

• After observation, there is immense need for improved traiging practices throught all three phases of care continuum.

• NIMHANS is on the cutting edges of neurotrauma care in India.

• Precedent for piloting interventions and innovative research.

• Unknown.

• Need to adapt GRYMTR to India. Existing data sources unknown.

• There are already modeling efforts for TBI triage at NIMHANS.

• Extent and purpose of these efforts remains unknown.

• Strong support from leadership will improve uptake.

• Possible local funding source.

• Immense potential for expantion.

• Support from top-level decision makers increase potential to scale.

• Potential GRYMTR applications for all three phases of care continuum.

-Unknown.

• Internet works with mifi device.
• See GRYMTR feedback document.

• Try to obtain TBI data.
• Flesh out registry proposal with Dr. Gururaj.