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Adem MA, Tezera ZB, Agegnehu CD. The practice and determinants of ambulance service utilization in pre-hospital settings, Jimma City, Ethiopia. BMC Emerg Med 2024; 24:81. [PMID: 38735937 PMCID: PMC11089792 DOI: 10.1186/s12873-024-00999-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 05/03/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND In pre-hospital setting, ambulance provides emergency care and means of transport to arrive at appropriate health centers are as vital as in-hospital care, especially, in developing countries. Accordingly, Ethiopia has made several efforts to improve accessibility of ambulances services in prehospital care system that improves the quality of basic emergency care. Yet, being a recent phenomenon in Ethiopia, empirical studies are inadequate with regard to the practice and determinants of ambulance service utilization in pre-hospital settings. Hence, this study aimed to assess the ambulance service utilization and its determinants among patients admitted to the Emergency Departments (EDs) within the context of pre-hospital care system in public hospitals of Jimma City. METHOD A cross-sectional study design was used to capture quantitative data in the study area from June to July 2022. A systematic sampling technique was used to select 451 participants. Interviewer-administered questionnaire was used to collect data. Data analysis was done using SPSS version 26.0; descriptive and logistic regressions were done, where statistical significance was determined at p < 0.05. RESULTS Ambulance service was rendered to bring about 39.5% (of total sample, 451) patients to hospitals. The distribution of service by severity of illnesses was 48.7% among high, and 39.4% among moderately acute cases. The major determinants of ambulance service utilization were: service time (with AOR, 0.35, 95%CI, 0.2-0.6 for those admitted to ED in the morning, and AOR, 2.36, 95%CI, 1.3-4.4 for those at night); referral source (with AOR, 0.2, 95%CI, 0.1-0.4 among the self-referrals); mental status (with AOR, 1.9, 95%CI, 1-3.5 where change in the level of consciousness is observed); first responder (AOR, 6.3 95%CI, 1.5-26 where first responders were the police, and AOR, 3.4, 95%C1, 1.7-6.6 in case of bystanders); distance to hospital (with AOR,0.37, 95%CI, 0.2-0.7 among the patients within ≤15km radius); and prior experience in ambulance use (with AOR, 4.1,95%CI, 2.4-7). CONCLUSION Although the utilization of ambulance in pre-hospital settings was, generally, good in Jimma City; lower levels of service use among patients in more acute health conditions is problematic. Community-based emergency care should be enhanced to improve the knowledge and use of ambulance services.
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Affiliation(s)
- Mohammed Ahmed Adem
- Department of Emergency and Critical Care, School of Nursing, Faculty of Health Sciences, Institute of Health, Jimma University main campus, 378, Jimma, Ethiopia.
| | - Zewdu Baye Tezera
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, 196, Gondar, Ethiopia
| | - Chilot Desta Agegnehu
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, 196, Gondar, Ethiopia
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Prust ML, Forman R, Ovbiagele B. Addressing disparities in the global epidemiology of stroke. Nat Rev Neurol 2024; 20:207-221. [PMID: 38228908 DOI: 10.1038/s41582-023-00921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities.
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Affiliation(s)
- Morgan L Prust
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Rachel Forman
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Bruce Ovbiagele
- Department of Neurology, University of California-San Francisco School of Medicine, San Francisco, CA, USA
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Kutoane M, Scott T, Brysiewicz P. "Feeling Like an Island": Perceptions of Professional Isolation Among Emergency Nurses. J Emerg Nurs 2023; 49:881-889. [PMID: 37656113 DOI: 10.1016/j.jen.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Professional isolation, feelings of being isolated from one's professional peers and lacking mentoring and opportunities for professional interaction, collaboration, and development, is a challenge for workers across the labor market. The notion of professional isolation is particularly prevalent in low-resource health care settings and is common among emergency nurses. METHODS This study explored the perceptions of professional isolation among emergency nurses working in a low-resource environment using individual interviews with 13 participants in 5 settings in Lesotho. RESULTS The data were analyzed using qualitative content analysis and revealed an overarching theme of "feeling like an island" containing 3 categories, namely lack of interprofessional collaboration and consultation, skills mismatch, and enforced loneliness. DISCUSSION This study suggests that lack of interprofessional collaboration and consultation, skills mismatch, and enforced loneliness have influenced feelings of professional isolation among emergency nurses working in low-resource environments. The findings of this research lend support to the idea that communities of practice may have a potential impact in addressing professional isolation.
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Nzasabimana P, Ignatowicz A, Alayande BT, Abdul-Latif AM, Odland ML, Davies J, Bekele A, Byiringiro JC. Barriers to equitable access to quality trauma care in Rwanda: a qualitative study. BMJ Open 2023; 13:e075117. [PMID: 37770259 PMCID: PMC10546151 DOI: 10.1136/bmjopen-2023-075117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVES Using the 'Four Delay' framework, our study aimed to identify and explore barriers to accessing quality injury care from the injured patients', caregivers' and community leaders' perspectives. DESIGN A qualitative study assessing barriers to trauma care comprising 20 in-depth semistructured interviews and 4 focus group discussions was conducted. The data were analysed thematically. SETTING This qualitative study was conducted in Rwanda's rural Burera District, located in the Northern Province, and in Kigali City, the country's urban capital, to capture both the rural and urban population's experiences of being injured. PARTICIPANTS Purposively selected participants were individuals from urban and rural communities who had accessed injury care in the previous 6 months or cared for the injured people, and community leaders. Fifty-one participants, 13 females and 38 males ranging from 21 to 68 years of age participated in interviews and focus group discussions. Thirty-six (71%) were former trauma patients with a wide range of injuries including fractured long bones (9, 45%), other fractures, head injury, polytrauma (3, 15% each), abdominal trauma (1, 5%), and lacerations (1, 5%), while the rest were caregivers and community leaders. RESULTS Multiple barriers were identified cutting across all levels of the 'Four Delays' framework, including barriers to seeking, reaching, receiving and remaining in care. Key barriers mentioned by participants in both interviews and focus group discussions were: lack of community health insurance, limited access to ambulances, insufficient number of trauma care specialists and a high volume of trauma patients. The rigid referral process and lack of decentralised rehabilitation services were also identified as significant barriers to accessing quality care for injured patients. CONCLUSIONS Future interventions to improve access to injury care in Rwanda must be informed by the identified barriers along the spectrum of care, from the point of injury to receipt of care and rehabilitation.
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Affiliation(s)
- Pascal Nzasabimana
- Single Project Implementation Unit, University of Rwanda, Kigali, Rwanda
| | | | - Barnabas Tobi Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Maria Lisa Odland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynecology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Malawi-Liverpool-Wellcome Trust Research Institute, Blantyre, Malawi
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Department of Global Health, Centre for Global Surgery, Stellenbosch University, Stellenbosch, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Abebe Bekele
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Jean Claude Byiringiro
- School of Medicine and Pharmacy, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
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Miima M, Marsuk E. Systemic emergency department performance in a low resource tertiary health facility in central Kenya: Micro level emergency care system evaluation. Afr J Emerg Med 2023; 13:121-126. [PMID: 37284332 PMCID: PMC10239690 DOI: 10.1016/j.afjem.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 05/13/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
Emergency care system (ECS) performance is a proxy indicator of emergency care (EC) response and health systems resilience. The Emergency Care and System Assessment tool (ECSA) provides a structure for measuring emergency department (ED) systemic performance, using high quality ECS metrics. These metrics aligned with WHO targeted priority action areas facilitate synergies in supporting ECS evaluation at the micro level. Retrospective file reviews and anecdotal evidence from a low resource tertiary health facility between 1st January 2020 - 31st May 2021 showed that: - the governance structure had administrative and financial autonomy from the public healthcare system, healthcare financing was mostly out of pocket (OPP) and the human resource ecosystem was structured in operations, enforcement and training to drive EC quality improvement. More than two thirds of the patients were high acuity but only 2% of the patients died. Most sentinel ED functions were available at the facility however the facility does not have a developed prehospital care, neurosurgical nor a burns unit. Micro ECS framework derived from ECSA objectively interrogates performance of the healthcare system that supports EC in a tertiary facility.
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Schnaubelt S, Garg R, Atiq H, Baig N, Bernardino M, Bigham B, Dickson S, Geduld H, Al-Hilali Z, Karki S, Lahri S, Maconochie I, Montealegre F, Tageldin Mustafa M, Niermeyer S, Athieno Odakha J, Perlman JM, Monsieurs KG, Greif R. Cardiopulmonary resuscitation in low-resource settings: a statement by the International Liaison Committee on Resuscitation, supported by the AFEM, EUSEM, IFEM, and IFRC. Lancet Glob Health 2023; 11:e1444-e1453. [PMID: 37591590 DOI: 10.1016/s2214-109x(23)00302-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/19/2023]
Abstract
Most recommendations on cardiopulmonary resuscitation were developed from the perspective of high-resource settings with the aim of applying them in these settings. These so-called international guidelines are often not applicable in low-resource settings. Organisations including the International Liaison Committee on Resuscitation (ILCOR) have not sufficiently addressed this problem. We formed a collaborative group of experts from various settings including low-income, middle-income, and high-income countries, and conducted a prospective, multiphase consensus process to formulate this ILCOR Task Force statement. We highlight the discrepancy between current cardiopulmonary resuscitation guidelines and their applicability in low-resource settings. Successful existing initiatives such as the Helping Babies Breathe programme and the WHO Emergency Care Systems Framework are acknowledged. The concept of the chainmail of survival as an adaptive approach towards a framework of resuscitation, the potential enablers of and barriers to this framework, and gaps in the knowledge are discussed, focusing on low-resource settings. Action points are proposed, which might be expanded into future recommendations and suggestions, addressing a large diversity of addressees from caregivers to stakeholders. This statement serves as a stepping-stone to developing a truly global approach to guide resuscitation care and science, including in health-care systems worldwide.
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Affiliation(s)
- Sebastian Schnaubelt
- European Resuscitation Council, Niel, Belgium; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr Braich All India Institute of Medical Sciences, New Delhi, India
| | - Huba Atiq
- Department of Anaesthesiology, Centre of Excellence for Trauma & Emergency, The Aga Khan University Hospital, Karachi, Pakistan
| | - Noor Baig
- Department of Emergency Medicine, Centre of Excellence for Trauma & Emergency, The Aga Khan University Hospital, Karachi, Pakistan
| | - Marta Bernardino
- Centro de Simulacion, Hospital Universitario Fundacion Alcorcon, Madrid, Spain; Spanish Society of Anaesthesiology and Intensive Care, Madrid, Spain
| | - Blair Bigham
- Department of Anesthesia, Division of Critical Care, Stanford University, Palo Alto, CA, USA
| | | | - Heike Geduld
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | | | - Sanjaya Karki
- Department of Emergency and Pre-hospital Care, Mediciti Hospital, Bhaisepati, Lalitpur, Nepal
| | - Sa'ad Lahri
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Imperial College Healthcare Trust, London, UK
| | - Fernando Montealegre
- Department of Anaesthesiology, José Casimiro Ulloa Emergency Hospital, Peruvian Resuscitation Council, Lima, Peru
| | | | - Susan Niermeyer
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Justine Athieno Odakha
- Department of Emergency Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jeffrey M Perlman
- Department of Pediatrics, Division of Newborn Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, NY, USA
| | - Koenraad G Monsieurs
- European Resuscitation Council, Niel, Belgium; Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Robert Greif
- European Resuscitation Council, Niel, Belgium; University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Non-hospital healthcare center's preparedness assessment toolbar for providing basic emergency care: a sequential exploratory mixed-method study. BMC Health Serv Res 2023; 23:70. [PMID: 36690961 PMCID: PMC9872316 DOI: 10.1186/s12913-023-09053-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Basic emergency management in urban and rural areas is a critical challenge, which can affect the pre-hospital mortality rate. Therefore, Non-hospital Healthcare Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The main aim of the study was to develop and validate an toolbar for NHHCs' preparedness to provide initial emergency care. METHODS This study was designed based on a sequential exploratory mixed- method in two phases, in each of which there are three steps. In the phase I, the literature systematic review and qualitative methods (Focus Group Discussions (FGDs) and Semi-Structured Interviews (SSIs)) were applied to identify the domains and items. In the phase II, content validity, feasibility, and reliability of the toolbar were performed. Content validity was assessed using a modified Kappa coefficient based on clarity and relevance criteria. Feasibility of the toolbar was randomly assessed through its implementation in 10 centers in Tabriz. Reliability was randomly assessed in a pilot on 30 centers. Reliability was assessed by measuring internal consistency, test-retest reliability, and inter-rater agreement. The main statistical methods for assessing reliability include Cronbach's alpha, Intra-class Correlation Coefficient, and Kendal's Tau-b. All the statistical analyses were performed using Stata 14. RESULTS In the phase I, primary version of the toolbar containing 134 items related to assessing the preparedness of NHHCs was generated. In the phase II, item reduction was applied and the final version of the toolbar was developed containing 126 items, respectively. These items were classified in 9 domains which include: "Environmental Infrastructures of Centers", "Protocols, Guidelines and Policies", "Medical Supplies and Equipment", "Emergency Medicines", "Human Resources", "Clinical Interventions", "Maintenance of equipment", "Medicine Storage Capability", and "Management Process". The toolbar had acceptable validity and reliability. CONCLUSIONS This study provided a standard and valid toolbar that can be used to assess the preparedness of NHHCs to deliver initial emergency care.
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Adem F, Abdi S, Amare F, Mohammed MA. In-hospital mortality from acute coronary syndrome in Africa: a systematic review and meta-analysis. SAGE Open Med 2023; 11:20503121221143646. [PMID: 36685798 PMCID: PMC9850135 DOI: 10.1177/20503121221143646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/18/2022] [Indexed: 01/18/2023] Open
Abstract
Objective There is an increasing recognition of the burden of cardiovascular disease in Africa. However, little is known about the pooled prevalence of acute coronary syndrome (ACS)-associated in-hospital mortality and contributing factors. Methods PubMed, Medline, Embase, Web of Science (Core Collection), and supplementary sources including Google Scholar, World Cat, Research Gate, and Cochrane Library were searched. Chi-square test and I 2-statistic were used to assess heterogeneity. Egger's and Begg's tests and funnel plots were used to assess publication bias. Data were analyzed using Stata software (version 15.0). Result Twenty nine studies with a total sample of 11,788 were included. The pooled estimate of all-cause in-hospital mortality was 22% (pooled proportion (PP) = 0.22; 95% confidence interval (CI): 0.17-0.27. The In-hospital mortality rate was lower at the cardiac centers (PP = 0.14; CI: 0.05-0.23) compared to referral hospitals (PP = 0.24; CI: 0.17-0.31]) The mortality rate was comparable in Eastern (PP = 0.23; CI: 0.19-0.27) and Northern Africa (PP = 0.22; CI: 0.16-0.28). The incidence of in-hospital heart failure, cardiogenic shock, arrhythmia, bleeding, acute stroke, and reinfarction were 42, 17.0, 20.0, 16.0, 4.0, and 5.0%, respectively. Conclusion All-cause in-hospital mortality rate associated with ACS is high in Africa. The mortality rate at cardiac centers was 10% lower when compared with referral hospitals. Establishing coronary units, strengthening existing cardiac services, and improving availability and access to cardiovascular medicines could help in reducing the burden of ACS in the continent.
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Affiliation(s)
- Fuad Adem
- Department of Clinical Pharmacy,
College of Health and Medical Sciences, Haramaya University, Haramaya, Oromia,
Ethiopia,Fuad Adem, Haramaya University College of
Health and Medical Sciences, Harar, Haramaya, Oromia 238, Ethiopia.
| | - Semir Abdi
- Department of Internal Medicine,
College of Health and Medical Sciences, Haramaya University, Haramaya, Oromia,
Ethiopia
| | - Firehiwot Amare
- Department of Pharmacology and Clinical
Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mohammed A Mohammed
- Faculty of Medical and Health Sciences,
School of Pharmacy, The University of Auckland, Auckland, New Zealand
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Epps L, Ramachandran A, Yi S, Mayah A, Burkholder T, Jaung M, Haider A, Wesseh P, Shakpeh J, Bills C, Enriquez K. Implementation and outcomes of a comprehensive emergency care curriculum at a low-resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit. PLoS One 2023; 18:e0282690. [PMID: 36921009 PMCID: PMC10016633 DOI: 10.1371/journal.pone.0282690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/21/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Emergency care is vital in low- and middle-income countries (LMICs) but many frontline healthcare workers in low-resource settings have no formal training in emergency care. To address this gap, the World Health Organization (WHO) developed Basic Emergency Care (BEC): Approach to the acutely ill and injured, a multi-day, open-source course for healthcare workers in low-resource settings. Building on the BEC foundation, this study uses an implementation science (IS) lens to develop, implement, and evaluate a comprehensive emergency care curriculum in a single emergency facility in Liberia. METHODS A six-month emergency care curriculum consisting of BEC content, standardized WHO clinical documentation forms, African Federation of Emergency Medicine (AFEM) didactics, and clinical mentorship by visiting emergency medicine (EM) faculty was designed and implemented using IS frameworks at Redemption Hospital, a low-resource public referral hospital in Monrovia, the capital of Liberia. Healthcare worker performance on validated knowledge-based exams during pre- and post-intervention testing, post-course surveys, and patient outcomes were used to evaluate the program. RESULTS Nine visiting EM physicians provided 1400 hours of clinical mentorship and 560 hours of didactic training to fifty-six Redemption Hospital staff over six-months. Median test scores improved 20.0% (p<0.001) among the forty-three healthcare workers who took both the pre- and post-intervention tests. Participants reported increased confidence in caring for medical and trauma patients and comfort performing emergency care tasks on post-course surveys. Emergency unit (EU)/Isolation unit (IU) mortality decreased during the six-month implementation period, albeit non-significantly. Course satisfaction was high across multiple domains. DISCUSSION This study builds on prior research supporting WHO efforts to improve emergency care globally. BEC implementation over a six-month timeframe using IS principles is an effective alternative strategy for facilities in resource-constrained environments wishing to strengthen emergency care delivery.
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Affiliation(s)
- Lane Epps
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States of America
- * E-mail:
| | - Anu Ramachandran
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Sojung Yi
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Alexander Mayah
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States of America
| | - Taylor Burkholder
- Department of Emergency Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Michael Jaung
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, United States of America
| | - Ahson Haider
- San Francisco State University, San Francisco, CA, United States of America
| | | | | | - Corey Bills
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States of America
| | - Kayla Enriquez
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States of America
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Botes M, Bruce J, Cooke R. How Health Care Practitioners experience emergencies at Primary Health Care facilities – Kinks in the chain of survival. Afr J Emerg Med 2022; 12:423-427. [PMID: 36211986 PMCID: PMC9531042 DOI: 10.1016/j.afjem.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/19/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background The 72nd World Health Assembly has recognised that emergency care at primary health care level is vital for reducing overall mortality and disability. The system of emergency care at this level is affected by various external factors. Little is known about these factors and how they shape the experiences of health care practitioners dealing with medical emergencies in Primary Health Care (PHC) settings. The objective of the study was to explore the experiences of health care practitioners in dealing with emergencies in PHC facilities in the Gauteng province of South Africa. Methods A qualitative formative evaluation approach was used. Data were collected using semi structured interviews and analysed using qualitative content analysis to describe the experiences of health care practitioners dealing with emergencies at a primary health care level. Participants included health care practitioners from various levels of the district health system. Results Major themes that emerged explored challenges faced by health care practitioners, the referral system and influential policy such as the ideal clinic movement.
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Mamalelala TT. Quality emergency care (QEC) in resource limited settings: A concept analysis. Int Emerg Nurs 2022; 64:101198. [PMID: 35926319 DOI: 10.1016/j.ienj.2022.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Providing appropriate high-quality emergency care (QEC) commensurate with patients' needs is critical for continuity of care, patient safety, optimal clinical outcomes, reduced mortality, and patient satisfaction. This concept analysis aims to define and assist in understanding the concept of QEC in resource-limited settings. METHODS Quality emergency care concept analysis was conducted using Walker and Avant's approach. Several literature review methods and dictionaries were used to explore the QEC concept. RESULTS Immediate assessment, rapid diagnosis, and critical interventions are the attributes of QEC for life-threatening and time-sensitive conditions, leading to timely and safe care provision. DISCUSSION Nurses serve as the backbone for most emergency care centers such as primary care, emergency department, and even prehospital care. The first few hours following a potential life- or limb-threatening condition are vital. The emergency care rendered to patients can significantly affect treatment's overall outcome; therefore, quality emergency care is critical. CONCLUSION
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Affiliation(s)
- Tebogo T Mamalelala
- School of Nursing, University of Botswana, Botswana; School of Nursing, Rutgers, The State University of New Jersey, USA.
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Vanichkulbodee A, Inboriboon PC, Balk AH, Sri-on J. Perception of an Introductory Point-of-Care Ultrasound Course for Thai Medical Students on Emergency Medicine Rotation. Open Access Emerg Med 2021; 13:291-298. [PMID: 34267560 PMCID: PMC8275160 DOI: 10.2147/oaem.s316730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Point-of-care ultrasonography (POCUS) is increasingly utilized in emergency departments (EDs) throughout Thailand. Although emergency medicine (EM) residents are trained in POCUS, Thai medical students receive limited training. An introductory POCUS course was implemented for medical students to prepare them for internships. OBJECTIVE This study described the perception and use of POCUS by graduates of an introductory POCUS course. MATERIALS AND METHODS Medical students who completed the POCUS course were surveyed during their intern year from 2012 to 2015. The survey collected demographic characteristics. The Likert Scale was used to assess POCUS practice patterns and perceptions of the course. RESULTS There were 230 respondents (98% response rate). All thought that POCUS was important. Furthermore, 96% of respondents felt that the POCUS course meaningfully impacted their ability to deliver care. POCUS use was greatest for obstetrics/gynecology and trauma cases. Over half of respondents (55.2%) felt very confident with using extended-Focused Assessment with Sonography in Trauma. Most respondents (81.8%) were positively impacted by the course, and 61.7% were satisfied with the scope of the course. Recommendations for improvement included increasing the course length, the content, and the hands-on time for POCUS practice. CONCLUSION Graduates positively perceived the course and felt it dramatically impacted their clinical practice as novice physicians. An introductory POCUS course should be incorporated into the medical school curriculum to prepare graduates for practice. Future goals include increasing the scope of POCUS practice to help guide interns and residents in emergency patient care such as lung ultrasound in COVID-19 or pneumonia patients and studying the impact this course has on patient outcomes.
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Affiliation(s)
- Alissara Vanichkulbodee
- Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
- Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA
| | | | - Andrew H Balk
- Department of Emergency Medicine, Truman Medical Center, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA
| | - Jiraporn Sri-on
- Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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