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Bani Odeh AA, Wallis LA, Hamdan M, Stassen W. Consensus-based quality standards for emergency departments in Palestine. BMJ Open Qual 2024; 13:e002598. [PMID: 38519089 PMCID: PMC10961511 DOI: 10.1136/bmjoq-2023-002598] [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: 09/09/2023] [Accepted: 02/29/2024] [Indexed: 03/24/2024] Open
Abstract
OBJECTIVES The present study aimed to establish appropriate quality standards for emergency departments (EDQS) in Palestine. METHODS The study comprised four phases. First, a comprehensive literature review was conducted to develop a framework for assessing healthcare services in EDs. Second, the initial set of EDQS was developed based on the review findings. Third, local experts provided feedback on the EDQS, suggesting additional standards, and giving recommendations. This feedback was analysed to create a preliminary set of EDQS. Finally, an expanded group of local emergency care experts evaluated the preliminary set, providing feedback on content and structure to contribute to the final set of EDQS. FINDINGS We identified quality domains in EDs and categorised them into clinical and administrative pathways. The clinical pathway comprises 39 standards across 7 subdomains: triage, treatment, transportation, medication safety, patient flow and medical diagnostic services. Expert consensus was achieved on 87.5% of these standards. The administrative domain includes 64 consensus-based standards across 9 subdomains: documentation, information management systems, access-location, design, leadership, management, workforce staffing, training, equipment, supplies, capacity-resuscitation rooms, resources for a safe working environment, performance indicators and patient safety-infection prevention and control programmes. CONCLUSION This study employed a rigorous approach to identify QS for EDs in Palestine. The multiphase consensus process ensured the appropriateness of the developed EDQS. Inclusion of diverse perspectives enriched the content. Future studies will validate and refine the standards based on feedback. The EDQS has potential to enhance emergency care in Palestine and serve as a model for other regions facing similar challenges.
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Affiliation(s)
| | - Lee A Wallis
- Emergency Medicince, University of Cape Town, Cape Town, Western Cape, South Africa
| | | | - Willem Stassen
- University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
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Mitchell R, White L, Elton L, Luke C, Bornstein S, Atua V. Triage implementation in resource-limited emergency departments: sharing tools and experience from the Pacific region. Int J Emerg Med 2024; 17:21. [PMID: 38355441 PMCID: PMC10865550 DOI: 10.1186/s12245-024-00583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024] Open
Abstract
According to the World Health Organization's (WHO) Emergency Care Systems Framework, triage is an essential function of emergency departments (EDs). This practice innovation article describes four strategies that have been used to support implementation of the WHO-endorsed Interagency Integrated Triage Tool (IITT) in the Pacific region, namely needs assessment, digital learning, public communications and electronic data management.Using a case study from Vila Central Hospital in Vanuatu, a Pacific Small Island Developing State, we reflect on lessons learned from IITT implementation in a resource-limited ED. In particular, we describe the value of a bespoke needs assessment tool for documenting triage and patient flow requirements; the challenges and opportunities presented by digital learning; the benefits of locally designed, public-facing communications materials; and the feasibility and impact of a low-cost electronic data registry system.Our experience of using these tools in Vanuatu and across the Pacific region will be of interest to other resource-limited EDs seeking to improve their triage practice and performance. Although the resources and strategies presented in this article are focussed on the IITT, the principles are equally relevant to other triage systems.
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Affiliation(s)
- Rob Mitchell
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia.
| | - Libby White
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia
| | - Leigh Elton
- National Critical Care & Trauma Response Centre, Darwin, Australia
| | - Cliff Luke
- Vila Central Hospital, Port Vila, Vanuatu
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McLeod M, Torode J, Leung K, Bhoo-Pathy N, Booth C, Chakowa J, Gralow J, Ilbawi A, Jassem J, Parkes J, Mallafré-Larrosa M, Mutebi M, Pramesh CS, Sengar M, Tsunoda A, Unger-Saldaña K, Vanderpuye V, Yusuf A, Sullivan R, Aggarwal A. Quality indicators for evaluating cancer care in low-income and middle-income country settings: a multinational modified Delphi study. Lancet Oncol 2024; 25:e63-e72. [PMID: 38301704 DOI: 10.1016/s1470-2045(23)00568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 02/03/2024]
Abstract
This Policy Review sourced opinions from experts in cancer care across low-income and middle-income countries (LMICs) to build consensus around high-priority measures of care quality. A comprehensive list of quality indicators in medical, radiation, and surgical oncology was identified from systematic literature reviews. A modified Delphi study consisting of three 90-min workshops and two international electronic surveys integrating a global range of key clinical, policy, and research leaders was used to derive consensus on cancer quality indicators that would be both feasible to collect and were high priority for cancer care systems in LMICs. Workshop participants narrowed the list of 216 quality indicators from the literature review to 34 for inclusion in the subsequent surveys. Experts' responses to the surveys showed consensus around nine high-priority quality indicators for measuring the quality of hospital-based cancer care in LMICs. These quality indicators focus on important processes of care delivery from accurate diagnosis (eg, histologic diagnosis via biopsy and TNM staging) to adequate, timely, and appropriate treatment (eg, completion of radiotherapy and appropriate surgical intervention). The core indicators selected could be used to implement systems of feedback and quality improvement.
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Affiliation(s)
- Megan McLeod
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Julie Torode
- Institute of Cancer Policy, Centre for Cancer, Society and Public Health, King's College London, London, UK
| | - Kari Leung
- Guy's and St Thomas' NHS Trust, London, UK
| | - Nirmala Bhoo-Pathy
- Department of Clinical Epidemiology, Universiti Malaya Medical Centre, Kuala Lampar, Malaysia
| | - Christopher Booth
- Department of Medical Oncology, Queen's University, Kingston, ON, Canada
| | | | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA, USA
| | | | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Jeannette Parkes
- Division of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Merixtell Mallafré-Larrosa
- City Cancer Challenge, Geneva, Switzerland; Department of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - C S Pramesh
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Audrey Tsunoda
- Department of Gynecologic Oncology, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | | | - Verna Vanderpuye
- National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Aasim Yusuf
- Department of Gastroenterology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar, Pakistan
| | - Richard Sullivan
- Institute of Cancer Policy, Centre for Cancer, Society and Public Health, King's College London, London, UK; Global Oncology Group, Centre for Cancer, Society and Public Health, King's College London, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Towns K, Dolo I, Pickering AE, Ludmer N, Karanja V, Marsh RH, Horace M, Dweh D, Dalieh T, Myers S, Bukhman A, Gashi J, Sonenthal P, Ulysse P, Cook R, Rouhani SA. Evaluation of emergency care education and triage implementation: an observational study at a hospital in rural Liberia. BMJ Open 2023; 13:e067343. [PMID: 37202137 DOI: 10.1136/bmjopen-2022-067343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION In Liberia, emergency care is still in its early development. In 2019, two emergency care and triage education sessions were done at J. J. Dossen Hospital in Southeastern Liberia. The observational study objectives evaluated key process outcomes before and after the educational interventions. METHODS Emergency department paper records from 1 February 2019 to 31 December 2019 were retrospectively reviewed. Simple descriptive statistics were used to describe patient demographics and χ2 analyses were used to test for significance. ORs were calculated for key predetermined process measures. RESULTS There were 8222 patient visits recorded that were included in our analysis. Patients in the post-intervention 1 group had higher odds of having a documented full set of vital signs compared with the baseline group (16% vs 3.5%, OR: 5.4 (95% CI: 4.3 to 6.7)). After triage implementation, patients who were triaged were 16 times more likely to have a full set of vitals compared with those who were not triaged. Similarly, compared with the baseline group, patients in the post-intervention 1 group had higher odds of having a glucose documented if they presented with altered mental status or a neurologic complaint (37% vs 30%, OR: 1.7 (95% CI: 1.3 to 2.2)), documented antibiotic administration if they had a presumed bacterial infection (87% vs 35%, OR: 12.8 (95% CI: 8.8 to 17.1)), documented malaria test if presenting with fever (76% vs 61%, OR: 2.05 (95% CI: 1.37 to 3.08)) or documented repeat set of vitals if presenting with shock (25% vs 6.6%, OR: 8.85 (95% CI: 1.67 to 14.06)). There was no significant difference in the above process outcomes between the education interventions. CONCLUSION This study showed improvement in most process measures between the baseline and post-intervention 1 groups, benefits that persisted post-intervention 2, thus supporting the importance of short-course education interventions to durably improve facility-based care.
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Affiliation(s)
- Kathleen Towns
- Division of Hospital Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Isaac Dolo
- Partners In Health Liberia, Harper, Liberia
| | - Ashley E Pickering
- Emergency Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Nicholas Ludmer
- Partners In Health, Boston, Massachusetts, USA
- Department of Emergency Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Regan H Marsh
- Partners In Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Denny Dweh
- Partners In Health Liberia, Harper, Liberia
| | | | | | - Alice Bukhman
- Partners In Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jason Gashi
- Boston University, Boston, Massachusetts, USA
| | - Paul Sonenthal
- Partners In Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Patrick Ulysse
- Partners In Health, Boston, Massachusetts, USA
- Partners In Health Liberia, Harper, Liberia
| | - Rebecca Cook
- Partners In Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Shada A Rouhani
- Partners In Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Pickering AE, Malherbe P, Nambuba J, Bills CB, Hynes EC, Rice B. Clinical emergency care quality indicators in Africa: a scoping review and data summary. BMJ Open 2023; 13:e069494. [PMID: 37130667 PMCID: PMC10163454 DOI: 10.1136/bmjopen-2022-069494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Emergency care services are rapidly expanding in Africa; however, development must focus on quality. The African Federation of Emergency Medicine consensus conference (AFEM-CC)-based quality indicators were published in 2018. This study sought to increase knowledge of quality through identifying all publications from Africa containing data relevant to the AFEM-CC process clinical and outcome quality indicators. DESIGN We conducted searches for general quality of emergency care in Africa and for each of 28 AFEM-CC process clinical and five outcome clinical quality indicators individually in the medical and grey literature. DATA SOURCES PubMed (1964-2 January 2022), Embase (1947-2 January 2022) and CINAHL (1982-3 January 2022) and various forms of grey literature were queried. ELIGIBILITY CRITERIA Studies published in English, addressing the African emergency care population as a whole or large subsegment of this population (eg, trauma, paediatrics), and matching AFEM-CC process quality indicator parameters exactly were included. Studies with similar, but not exact match, data were collected separately as 'AFEM-CC quality indicators near match'. DATA EXTRACTION AND SYNTHESIS Document screening was done in duplicate by two authors, using Covidence, and conflicts were adjudicated by a third. Simple descriptive statistics were calculated. RESULTS One thousand three hundred and fourteen documents were reviewed, 314 in full text. 41 studies met a priori criteria and were included, yielding 59 unique quality indicator data points. Documentation and assessment quality indicators accounted for 64% of data points identified, clinical care for 25% and outcomes for 10%. An additional 53 'AFEM-CC quality indicators near match' publications were identified (38 new publications and 15 previously identified studies that contained additional 'near match' data), yielding 87 data points. CONCLUSIONS Data relevant to African emergency care facility-based quality indicators are highly limited. Future publications on emergency care in Africa should be aware of, and conform with, AFEM-CC quality indicators to strengthen understanding of quality.
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Affiliation(s)
- Ashley E Pickering
- Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Petrus Malherbe
- Emergency Medicine, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Joan Nambuba
- Emergency Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Corey B Bills
- Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Emilie Calvello Hynes
- Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Brian Rice
- Emergency Medicine, Stanford University, Palo Alto, California, USA
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Hirner S, Dhakal J, Broccoli MC, Ross M, Calvello Hynes EJ, Bills CB. Defining measures of emergency care access in low-income and middle-income countries: a scoping review. BMJ Open 2023; 13:e067884. [PMID: 37068910 PMCID: PMC10111883 DOI: 10.1136/bmjopen-2022-067884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Over 50% of annual deaths in low-income and middle-income countries (LMICs) could be averted through access to high-quality emergency care. OBJECTIVES We performed a scoping review of the literature that described at least one measure of emergency care access in LMICs in order to understand relevant barriers to emergency care systems. ELIGIBILITY CRITERIA English language studies published between 1 January 1990 and 30 December 2020, with one or more discrete measure(s) of access to emergency health services in LMICs described. SOURCE OF EVIDENCE PubMed, Embase, Web of Science, CINAHL and the grey literature. CHARTING METHODS A structured data extraction tool was used to identify and classify the number of 'unique' measures, and the number of times each unique measure was studied in the literature ('total' measures). Measures of access were categorised by access type, defined by Thomas and Penchansky, with further categorisation according to the 'Three Delay' model of seeking, reaching and receiving care, and the WHO's Emergency Care Systems Framework (ECSF). RESULTS A total of 3103 articles were screened. 75 met full study inclusion. Articles were uniformly descriptive (n=75, 100%). 137 discrete measures of access were reported. Unique measures of accommodation (n=42, 30.7%) and availability (n=40, 29.2%) were most common. Measures of seeking, reaching and receiving care were 22 (16.0%), 46 (33.6%) and 69 (50.4%), respectively. According to the ECSF slightly more measures focused on prehospital care-inclusive of care at the scene and through transport to a facility (n=76, 55.4%) as compared with facility-based care (n=57, 41.6%). CONCLUSIONS Numerous measures of emergency care access are described in the literature, but many measures are overaddressed. Development of a core set of access measures with associated minimum standards are necessary to aid in ensuring universal access to high-quality emergency care in all settings.
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Affiliation(s)
- Sarah Hirner
- School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jyotshila Dhakal
- College Undergraduate Degree Programs & Studies, University of Colorado Denver, Denver, Colorado, USA
| | | | - Madeline Ross
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Emilie J Calvello Hynes
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
| | - Corey B Bills
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
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Hughes M, Schmidt J, Svenson J. Emergency Services Capacity of a Rural Community in Guatemala. West J Emerg Med 2022; 23:746-753. [PMID: 36205672 PMCID: PMC9541976 DOI: 10.5811/westjem.2022.7.56258] [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: 01/08/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Access to emergency care is an essential part of the health system. Improving access to emergency services in low- and middle-income countries (LMIC) decreases mortality and reduces global disparities; however, few studies have assessed emergency services resources in LMICs. To guide future improvements in care, we performed a comprehensive assessment of the emergency services capacity of a rural community in Guatemala serving a mostly indigenous population. Methods We performed an exhaustively sampled cross-sectional survey of all healthcare facilities providing urgent and emergent care in the four largest cities surrounding Lake Atitlán using the Emergency Services Resource Assessment Tool (ESRAT). Results Of 17 identified facilities, 16 agreed to participate and were surveyed: nine private hospitals; four public clinics; and three public hospitals, including the region’s public departmental hospital. All facilities provided emergency services 24/7, and a dedicated emergency unit was available at 67% of hospitals and 75% of clinics. A dedicated physician was present in the emergency unit during the day at 67% of hospitals and 75% of clinics. Hospitals had a significantly higher percentage of available equipment compared to clinics (85% vs 54%, mean difference 31%; 95% confidence interval (CI) 23–37%; P = 0.004). There was no difference in availability of laboratory tests between public and private hospitals or between cities. Private hospitals had access to a significantly higher percentage of medications compared to clinics (56% vs 27%, mean difference 29%; 95% CI 9–49%; P = 0.024). Conclusion We found a high availability of emergency services and universal availability of personal protective equipment but a severe shortage of critical medications in clinics, and widespread shortage of pediatric equipment.
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Affiliation(s)
- Matthew Hughes
- University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine, Madison, Wisconsin
| | - Jessica Schmidt
- University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine, Madison, Wisconsin
| | - James Svenson
- University of Wisconsin School of Medicine and Public Health Department of Emergency Medicine, Madison, Wisconsin
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Anto-Ocrah M, Aboagye RG, Hasman L, Ghanem A, Owusu-Agyei S, Buranosky R. The elephant in the room: Intimate partner violence, women, and traumatic brain injury in sub-Saharan Africa. Front Neurol 2022; 13:917967. [PMID: 36147046 PMCID: PMC9485886 DOI: 10.3389/fneur.2022.917967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background Intimate partner violence (IPV) is a gendered form of violence that has been linked with traumatic brain injury (TBI). The prevalence of IPV in sub-Saharan Africa (SSA) is estimated to be one of the highest globally. Yet, little is known about the association between IPV and TBI in the SSA context. In this scoping review, we examine the intersection between IPV and TBI in SSA to identify gaps, as well as intervention opportunities. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Review (PRISMA-ScR) guidelines to guide our analyses and reporting, we searched for published articles indexed in the four largest and most comprehensive library databases: Pubmed, Embase, Web of Science and PsychInfo. Given the increasing attention that has been placed on gender disparities and health in recent years, we focused on studies published between 2010 and 2021. Results Our search yielded 5,947 articles and 1,258 were IPV and SSA related. Out of this, only ten examined the intersection between IPV and TBI. All focused on outcomes in female populations from South Africa (n = 5), Ghana (n = 3), Uganda (n = 1), and Cameroon (n = 1). They were a mix of qualitative studies (n = 3), neuro-imaging/biomarker studies (n = 3), case studies/reports (n = 2), quantitative surveys (n = 1) and mixed qualitative/quantitative study (n = 1). Six studies evaluated subjective reporting of IPV-induced TBI symptoms such as headaches, sleep disruptions, and ophthalmic injuries. Three examined objective assessments and included Hypothalamic-Pituitary-Adrenal (HPA) dysregulation detected by salivary cortisol levels, magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) to evaluate brain connectivity and white matter changes. One final study took a forensic anthropology lens to document an autopsy case report of IPV-induced mortality due to physical head and face trauma. Conclusion Our findings demonstrate that both subjective and objective assessments of IPV and TBI are possible in “resource-limited” settings. The combination of these outcomes will be critical for viewing IPV through a clinical rather than a cultural lens, and for substantiating the assertion that gender, is indeed, a social determinant of brain health.
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Affiliation(s)
- Martina Anto-Ocrah
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- *Correspondence: Martina Anto-Ocrah
| | - Richard Gyan Aboagye
- Department of Family and Community Health, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Linda Hasman
- Institute for Innovative Education: Miner Libraries, University of Rochester Medical Center, Rochester, NY, United States
| | - Ali Ghanem
- Institute for Global Health, University College London, London, United Kingdom
| | - Seth Owusu-Agyei
- Institute of Health Research, University of Health and Allied Sciences, Hohoe, Ghana
| | - Raquel Buranosky
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Cuervo LG, Martinez-Herrera E, Osorio L, Hatcher-Roberts J, Cuervo D, Bula MO, Pinilla LF, Piquero F, Jaramillo C. Dynamic accessibility by car to tertiary care emergency services in Cali, Colombia, in 2020: cross-sectional equity analyses using travel time big data from a Google API. BMJ Open 2022; 12:e062178. [PMID: 36581989 PMCID: PMC9438204 DOI: 10.1136/bmjopen-2022-062178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To test a new approach to characterise accessibility to tertiary care emergency health services in urban Cali and assess the links between accessibility and sociodemographic factors relevant to health equity. DESIGN The impact of traffic congestion on accessibility to tertiary care emergency departments was studied with an equity perspective, using a web-based digital platform that integrated publicly available digital data, including sociodemographic characteristics of the population and places of residence with travel times. SETTING AND PARTICIPANTS Cali, Colombia (population 2.258 million in 2020) using geographic and sociodemographic data. The study used predicted travel times downloaded for a week in July 2020 and a week in November 2020. PRIMARY AND SECONDARY OUTCOMES The share of the population within a 15 min journey by car from the place of residence to the tertiary care emergency department with the shortest journey (ie, 15 min accessibility rate (15mAR)) at peak-traffic congestion hours. Sociodemographic characteristics were disaggregated for equity analyses. A time-series bivariate analysis explored accessibility rates versus housing stratification. RESULTS Traffic congestion sharply reduces accessibility to tertiary emergency care (eg, 15mAR was 36.8% during peak-traffic hours vs 84.4% during free-flow hours for the week of 6-12 July 2020). Traffic congestion sharply reduces accessibility to tertiary emergency care. The greatest impact fell on specific ethnic groups, people with less educational attainment and those living in low-income households or on the periphery of Cali (15mAR: 8.1% peak traffic vs 51% free-flow traffic). These populations face longer average travel times to health services than the average population. CONCLUSIONS These findings suggest that health services and land use planning should prioritise travel times over travel distance and integrate them into urban planning. Existing technology and data can reveal inequities by integrating sociodemographic data with accurate travel times to health services estimates, providing the basis for valuable indicators.
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Affiliation(s)
- Luis Gabriel Cuervo
- Department of Paediatrics, Obstetrics & Gynaecology and Preventative Medicine, Universitat Autònoma de Barcelona, Washington, Cataluña, Spain
| | - Eliana Martinez-Herrera
- Epidemiology Research Group, National School of Public Health, Universidad de Antioquia, Medellín, Colombia
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain
| | - Lyda Osorio
- Escuela de Salud Pública, Facultad de Salud, Universidad del Valle, Cali, Valle del Cauca, Colombia
| | - Janet Hatcher-Roberts
- WHO Collaborating Centre for Knowledge Translation, Technology Assessment for Health Equity, Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada
- School of Public Health and Epidemiology, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | | | - Ciro Jaramillo
- School of Civil and Geomatic Engineering, Universidad del Valle, Cali, Valle del Cauca, Colombia
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Mould‐Millman N, Dixon J, Lee M, Meese H, Mata LV, Burkholder T, Moreira F, Bester B, Thomas J, de Vries S, Wallis LA, Ginde AA. Measuring quality of pre-hospital traumatic shock care-development and validation of an instrument for resource-limited settings. Health Sci Rep 2021; 4:e422. [PMID: 34693030 PMCID: PMC8516037 DOI: 10.1002/hsr2.422] [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: 07/16/2021] [Revised: 09/09/2021] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND AIMS Improving the quality of pre-hospital traumatic shock care, especially in low- and middle-income countries, is particularly relevant to reducing the large global burden of disease from injury. What clinical interventions represent high-quality care is an actively evolving field and often dependent on the specific injury pattern. A key component of improving the quality of care is having a consistent way to assess and measure the quality of shock care in the pre-hospital setting. The objective of this study was to develop and validate a chart abstraction instrument to measure the quality of trauma care in a resource-limited, pre-hospital emergency care setting. METHODS Traumatic shock was selected as the tracer condition. The pre-hospital quality of traumatic shock care (QTSC) instrument was developed and validated in three phases. A content development phase utilized a rapid literature review and expert consensus to yield the contents of the draft instrument. In the instrument validation phase, the QTSC instrument was created and underwent end user and content validation. A pilot-testing phase collected user feedback and performance characteristics to iteratively refine draft versions into a final instrument. Accuracy and inter- and intra-rater agreement were calculated. RESULTS The final QTSC instrument contains 10 domains of quality, each with specific criteria that determine how the domain is measured and the level of quality of care rendered. The instrument is over 90% accurate and has good inter- and intra-rater reliability when used by trained pre-hospital provider users in South Africa. Pre-hospital provider user feedback indicates the tool is easy to learn and quick to use. CONCLUSION We created and validated a novel chart abstraction instrument that can reliably and accurately measure the quality of pre-hospital traumatic shock care. We provide a systematic methodology for developing and validating a quality of care tool for resource-limited care settings.
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Affiliation(s)
- Nee‐Kofi Mould‐Millman
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Julia Dixon
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Michael Lee
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Halea Meese
- Department of Family and Community MedicineUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | - Lina V. Mata
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Taylor Burkholder
- Department of Emergency MedicineUniversity of Southern California, Keck School of MedicineCaliforniaLos AngelesUSA
| | - Fabio Moreira
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Beatrix Bester
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Jacob Thomas
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS)University of Colorado DenverAuroraColoradoUSA
| | - Shaheem de Vries
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
| | - Lee A. Wallis
- Western Cape Government, Department of HealthEmergency Medical ServicesCape TownSouth Africa
- Division of Emergency Medicine, Faculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
| | - Adit A. Ginde
- Department of Emergency MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
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11
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Bergquist HB, Burkholder TW, Muhammad Ali OA, Omer Y, Wallis LA. Considerations for service delivery for emergency care in low resource settings. Afr J Emerg Med 2020; 10:S7-S11. [PMID: 33318895 PMCID: PMC7723907 DOI: 10.1016/j.afjem.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/12/2020] [Accepted: 07/06/2020] [Indexed: 11/25/2022] Open
Abstract
In a shift from the more traditional disease focused model of global health interventions, increasing attention is now being placed on the importance of strengthening healthcare systems as a key component for achieving improved health outcomes. As emergency care systems continue to develop and strengthen around the world, the concept of service delivery provides one way to assess how well these systems are functioning. By focusing on service delivery, a system can be evaluated based on its ability to provide patients with access to the high-quality emergency care that they deserve. While the concept of service delivery is commonly used to evaluate the effectiveness of care in high-resource settings, its use in low resource settings has previously been limited due to challenges in operationalizing the concept in a context appropriate way. This article will begin by discussing the concept of service delivery as it specifically applies to emergency care systems and then discuss some of the challenges in defining and assessing this concept in low resource settings. The article will then discuss several new tools that have been developed to specifically address ways to evaluate emergency care service delivery in low-resource settings that can be used to inform future systems strengthening activities.
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12
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Hunie M, Desse T, Fenta E, Teshome D, Gelaw M, Gashaw A. Availability of Emergency Drugs and Essential Equipment in Intensive Care Units in Hospitals of Ethiopia: A Multicenter Cross-Sectional Study. Open Access Emerg Med 2020; 12:435-440. [PMID: 33293877 PMCID: PMC7719042 DOI: 10.2147/oaem.s285695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Emergency drugs and essential equipment are important to successfully manage patients in the intensive care unit (ICUs). The absence of these emergency drugs and essential equipment might result in mortality and morbidity which is more compounded in resource-limited settings. This study aims to assess the availability of emergency drugs and essential equipment in ICUs in hospitals in Ethiopia. Materials and Methods A cross-sectional descriptive study design was employed in the intensive care unit of nine Amhara regional state hospitals in Ethiopia. This study was done from August 01, 2020, to September 01, 2020. The data were collected using a structured questionnaire, which were adopted from the Emergency Medicine Society of South Africa (EMSSA) guidelines. Tables and narration were used to describe results. Results There were deficiencies of essential emergency items particularly in the pediatrics domain, devices to confirm tracheal intubation and equipment for managing difficult intubation. Emergency drugs like adrenaline, salbutamol puff, atropine, aspirin, furosemide, hydrocortisone, insulin, lidocaine, and medical oxygen were available in all ICUs, whereas amiodarone, sodium bicarbonate, glucagon, ipratropium nebulization, thiamine were not available in all ICUs. Conclusions and Recommendations There were considerable deficiencies in emergency drugs and essential equipment. Based on our findings, we recommend to develop standardized checklists, regular audits, and healthcare personnel awareness program to improve checking, maintaining, restocking, and repairing the equipment in the emergency trolley.
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Affiliation(s)
- Metages Hunie
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tiruwork Desse
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Efrem Fenta
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Diriba Teshome
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Moges Gelaw
- Department of Anesthesia, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amanu Gashaw
- Department of Anesthesia, School of Medicine, College of Health Science, Hawassa University, Hawassa, Sidama, Ethiopia
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13
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Lecky FE, Reynolds T, Otesile O, Hollis S, Turner J, Fuller G, Sammy I, Williams-Johnson J, Geduld H, Tenner AG, French S, Govia I, Balen J, Goodacre S, Marahatta SB, DeVries S, Sawe HR, El-Shinawi M, Mfinanga J, Rubiano AM, Chebbi H, Do Shin S, Ferrer JME, Haddadi M, Firew T, Taubert K, Lee A, Convocar P, Jamaluddin S, Kotecha S, Yaqeen EA, Wells K, Wallis L. Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): results of research prioritisation setting exercise. BMC Emerg Med 2020; 20:68. [PMID: 32867675 PMCID: PMC7457362 DOI: 10.1186/s12873-020-00362-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND More than half of deaths in low- and middle-income countries (LMICs) result from conditions that could be treated with emergency care - an integral component of universal health coverage (UHC) - through timely access to lifesaving interventions. METHODS The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt, Nepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and Phillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the strengthening of emergency care systems in limited-resource settings. RESULTS The RPS proposed seven priority research questions addressing: identification of context-relevant emergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential quality improvement via registries; characteristics of people seeking emergency care; best practices for staff training and retention; and cost effectiveness of critical care - all within LMICs. CONCLUSIONS Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research Network project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for strengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the current evidence supporting the identified priorities.
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Affiliation(s)
- Fiona E Lecky
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | | | - Olubukola Otesile
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | - Sara Hollis
- World Health Organisation, Geneva, Switzerland
| | - Janette Turner
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | - Gordon Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | - Ian Sammy
- Scarborough General Hospital, Tobago, Canada
| | | | - Heike Geduld
- Divsion of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | | | | | - Ishtar Govia
- The University of West Indies, Kingston, Jamaica
| | - Julie Balen
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | | | - Shaheem DeVries
- Emergency Medical Services for the Western Cape Government, Cape Town, South Africa
| | - Hendry R Sawe
- Emergency Medical Association of Tanzania (EMAT), Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | | | - Juma Mfinanga
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Andrés M Rubiano
- Neurosciences Institute, El Bosque University, Bogotá, Colombia
- Colombian Trauma Association, Bogotá, Colombia
| | | | - Sang Do Shin
- Seoul National University Hospital, Seoul, South Korea
| | | | | | - Tsion Firew
- Columbia University, Emergency Medicine, New York, NY, USA
- Ministry of Health, Addis Ababa, Ethiopia
| | | | - Andrew Lee
- School of Health and Related Research, University of Sheffield, Sheffield, and Emergency Deparment, Salford Royal Hospital, Salford, UK
| | - Pauline Convocar
- Philippine College of Emergency Medicine, Parañaque, Philippines
| | | | | | | | - Katie Wells
- Divsion of Emergency Medicine, University of Vermont, Burlington, Vermont, USA
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, F51 Old Main Building, Groote Schuur Hospital Observatory, Cape Town, South Africa.
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14
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Phillips G, Creaton A, Airdhill-Enosa P, Toito'ona P, Kafoa B, O'Reilly G, Cameron P. Emergency care status, priorities and standards for the Pacific region: A multiphase survey and consensus process across 17 different Pacific Island Countries and Territories. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 1:100002. [PMID: 34173588 PMCID: PMC7382998 DOI: 10.1016/j.lanwpc.2020.100002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 11/27/2022]
Abstract
Background Effective emergency care (EC) reduces mortality, aids disaster and outbreak response, and is necessary for universal health coverage. Surge events frequently challenge Pacific Island Countries and Territories (PICTs), where robust routine EC is required for resilient health systems. We aimed to describe the current status, determine priority actions and set minimum standards for EC systems development across the Pacific region. Methods We used a prospective, multiphase, expert consensus process to collect data from PICT EC stakeholders using focus groups, electronic surveys and panel review between August 2018 and April 2019. Data were analysed using descriptive statistics, consensus agreement and graphic interpretation. We structured the research according to the World Health Organisation EC Systems and building block framework adapted for the Pacific context. Findings Over 200 participants from 17 PICTs engaged in at least one component of the multiphase process. Gaps in functional capacity exist in most PICTs for both facility-based and pre-hospital care. EC is a low priority across the Pacific and integrated poorly with disaster plans. Participants emphasised human resource support and government recognition of EC as priority actions, and generated 24 facility-based and 22 pre-hospital Pacific EC standards across all building blocks. Interpretation PICT stakeholders now have baseline indicators and a comprehensive roadmap for EC development within a globally recognised health systems framework. This study generates practical, context-appropriate tools to trigger further research, conduct evidence-based advocacy, drive future improvements and measure progress towards achieving universal health access for Pacific peoples. Funding Secretariat of the Pacific Community (partial)
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Affiliation(s)
- Georgina Phillips
- School of Public Health and Preventive Medicine, Monash University, 553St. Kilda Rd., Melbourne, VIC 3004, Australia.,Emergency Physician, Emergency Department, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Anne Creaton
- School of Public Health and Preventive Medicine, Monash University, 553St. Kilda Rd., Melbourne, VIC 3004, Australia.,Emergency Physician, West Gippsland Healthcare Group, VIC, Australia
| | - Pai Airdhill-Enosa
- Director, Emergency Department, Tupua Tamasese Meaole Hospital, Apia, Samoa
| | - Patrick Toito'ona
- Deputy Director, Emergency Department, National Referral Hospital, Honiara, Solomon Islands
| | - Berlin Kafoa
- Director, Clinical Services Program, Public Health Division, Secretariat of the Pacific Community, Suva, Fiji
| | - Gerard O'Reilly
- School of Public Health and Preventive Medicine, Monash University, 553St. Kilda Rd., Melbourne, VIC 3004, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, 553St. Kilda Rd., Melbourne, VIC 3004, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
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15
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Kannan V, Tenner A, Sawe H, Osiro M, Kyobe T, Nahayo E, Rasamimanana N, Kivlehan S, Moresky R. Emergency care systems in Africa: A focus on quality. Afr J Emerg Med 2020; 10:S65-S72. [PMID: 33318905 PMCID: PMC7723896 DOI: 10.1016/j.afjem.2020.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/18/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022] Open
Abstract
Emergency care systems (ECS) are undergoing a period of rapid development on the African continent. What were formerly large intake zones are now being shaped into dedicated emergency units. Emergency care providers are being trained via certificate and even residency programs. However, significant challenges still exist. Resource limitations, staffing, and other system inputs are often the easiest issues to identify, but they only account for part of the problem. There are other prominent barriers to the delivery of high quality emergency care including lack of governmental leadership, poor system and facility organization, lack of provider training, and community misunderstanding of ECS functions. Released in May 2019, World Health Assembly (WHA) 72 resolution 12.9 "Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured" has squarely placed ECS strengthening as a priority item to member state governments. Moving forward, it will be important to ensure that these systems are set up for success, as high-quality emergency care systems have the potential to avert half of all deaths in low- and middle-income countries (LMIC). With momentum building from the recent WHA amendment and the health systems community more focused than ever on the consideration of quality in health systems design, it is of the utmost importance that ECS planners dovetail these interests such that these nascent systems are designed while 1) applying a systems thinking lens and 2) maintaining a focus on quality. This article helps to accomplish this by breaking down ECS into five major categories for evaluation as defined by the WHO Emergency Care Systems Assessment tool, providing an understanding of the functions of each, and identifying which indicators might be used to gauge performance. We also reinforce the notion that these indicators must dive deeper than system inputs and health outcomes, they must be patient centered in order to truly be reflective of success.
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Affiliation(s)
- V.C. Kannan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - A. Tenner
- University of California San Francisco, San Francisco, CA, USA
| | - H.R. Sawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - M. Osiro
- Department of Emergency Medical Services, Ministry of Health, Uganda
| | - T. Kyobe
- Association of Ambulance Professionals Uganda, Kampala, Uganda
| | - E. Nahayo
- Emergency Department, Centre Hospitalier Universitaire de Kigali, Rwanda
| | | | - S. Kivlehan
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - R. Moresky
- Columbia Mailman School of Public Health, New York, NY, USA
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16
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Rybarczyk MM, Ludmer N, Broccoli MC, Kivlehan SM, Niescierenko M, Bisanzo M, Checkett KA, Rouhani SA, Tenner AG, Geduld H, Reynolds T. Emergency Medicine Training Programs in Low- and Middle-Income Countries: A Systematic Review. Ann Glob Health 2020; 86:60. [PMID: 32587810 PMCID: PMC7304456 DOI: 10.5334/aogh.2681] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Despite the growing interest in the development of emergency care systems and emergency medicine (EM) as a specialty globally, there still exists a significant gap between the need for and the provision of emergency care by specialty trained providers. Many efforts to date to expand the practice of EM have focused on programs developed through partnerships between higher- and lower-resource settings. Objective To systematically review the literature to evaluate the composition of EM training programs in low- and middle-income countries (LMICs) developed through partnerships. Methods An electronic search was conducted using four databases for manuscripts on EM training programs - defined as structured education and/or training in the methods, procedures, and techniques of acute or emergency care - developed through partnerships. The search produced 7702 results. Using a priori inclusion and exclusion criteria, 94 manuscripts were included. After scoring these manuscripts, a more in-depth examination of 26 of the high-scoring manuscripts was conducted. Findings Fifteen highlight programs with a focus on specific EM content (i.e. ultrasound) and 11 cover EM programs with broader scopes. All outline programs with diverse curricula and varied educational and evaluative methods spanning from short courses to full residency programs, and they target learners from medical students and nurses to mid-level providers and physicians. Challenges of EM program development through partnerships include local adaptation of international materials; addressing the local culture(s) of learning, assessment, and practice; evaluation of impact; sustainability; and funding. Conclusions Overall, this review describes a diverse group of programs that have been or are currently being implemented through partnerships. Additionally, it highlights several areas for program development, including addressing other topic areas within EM beyond trauma and ultrasound and evaluating outcomes beyond the level of the learner. These steps to develop effective programs will further the advancement of EM as a specialty and enhance the development of effective emergency care systems globally.
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Affiliation(s)
- Megan M. Rybarczyk
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Nicholas Ludmer
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, US
| | | | - Sean M. Kivlehan
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Michelle Niescierenko
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, US
| | - Mark Bisanzo
- Division of Emergency Medicine, Department of Surgery, University of Vermont, US
| | - Keegan A. Checkett
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, US
| | - Shada A. Rouhani
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Andrea G. Tenner
- Department of Emergency Medicine, University of California, San Francisco, US
| | - Heike Geduld
- University of Cape Town/Stellenbosch University, College of Emergency Medicine of South Africa, ZA
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17
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Mitchell RD, O'Reilly GM, Phillips GA, Sale T, Roy N. Developing a research question: A research primer for low- and middle-income countries. Afr J Emerg Med 2020; 10:S109-S114. [PMID: 33304792 PMCID: PMC7718466 DOI: 10.1016/j.afjem.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022] Open
Abstract
As demand for emergency care (EC) systems in low- and middle-income countries (LMICs) grows, there is an urgent need to expand the evidence base for clinical and systems interventions in resource limited EC settings. Clinicians are well placed to identify, define and address unanswered research questions using both quantitative and qualitative approaches. This paper summarises established research priorities for global EC and provides a step-wise approach to developing a research question. Research priorities for global EC broadly fall into two categories: systems-based research and research with a clinical care focus. Systems research is integral to understanding the essential components of safe and effective EC delivery, while clinical research aims to answer questions related to particular disease states, presentations or population groups. Developing a specific research question requires an enquiring, questioning and critical approach to EC delivery. In quantitative research, use of the PECO formula (Population, Exposure, Comparator, Outcome) can help frame a research question. Qualitative research, which aims to understand, explore and examine, often requires application of a theoretical framework. Writing a brief purpose statement can be a helpful tool to clarify the objectives of a qualitative study. This paper includes lists of tips, pitfalls and resources to assist EC clinical researchers in developing research questions. Application of these tools and frameworks will assist EC clinicians in resource limited settings to perform impactful research and improve outcomes for patients with acute illness and injury.
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Affiliation(s)
- Rob D. Mitchell
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Corresponding author. @robdmitchell
| | - Gerard M. O'Reilly
- Emergency & Trauma Centre, Alfred Hospital, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Georgina A. Phillips
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency Department, St Vincent's Hospital, Melbourne, Australia
| | - Trina Sale
- National Referral Hospital, Honiara, Solomon Islands
| | - Nobhojit Roy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Dept of Surgery, BARC Hospital (Govt. of India), Mumbai, India
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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18
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Anto-Ocrah M, Maxwell N, Cushman J, Acheampong E, Kodam RS, Homan C, Li T. Public knowledge and attitudes towards bystander cardiopulmonary resuscitation (CPR) in Ghana, West Africa. Int J Emerg Med 2020; 13:29. [PMID: 32522144 PMCID: PMC7288511 DOI: 10.1186/s12245-020-00286-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Early bystander cardiopulmonary resuscitation (CPR) is one of the most important predictors of out-of-hospital cardiac arrests (OHCA) survival. There is a dearth of literature on CPR engagement in countries such as Ghana, where cardiovascular events are increasingly prevalent. In this study, we sought to evaluate Ghanaians' knowledge of and attitudes towards bystander CPR, in the context of the country's nascent emergency medicine network. METHODS Capitalizing on the growing ubiquity and use of social media across the country, we used a novel social media sampling strategy for this study. We created, pre-tested, and distributed an online survey, using the two most utilized social media platforms in Ghana: WhatsApp and Facebook. An airtime data incentive of 5 US dollars, worth between 5 and 10 GB of cellular data based on mobile phone carrier, was provided as incentive. Inclusion criteria were (1) ≥ 18 years of age, (2) living in Ghana. Survey participants were encouraged to distribute the survey within their own networks to expand its reach. We stratified participants' responses by healthcare affiliation, and further grouped healthcare workers into ambulance and non-ambulance personnel. We used chi-square (χ2)/Fisher's Exact tests to compare differences in responses between the groups. Based on the question "have you ever heard of CPR?", an alpha of 0.05 and a 95% confidence interval, we expected to have 80% power to detect a 15% difference in responses between lay and healthcare providers with an estimated sample size of 246 study participants. RESULTS The survey was launched on 8 July 2019 and closed approximately 51 h post-launch. With a 64% completion rate and 479 unique survey completions, the study was overpowered at 96% power, to detect differences in responses between the groups. There was geographic representation across all 10 historic regions of Ghana. Over half (57.8%, n = 277) of the respondents were non-medically affiliated, and 71.9% were women. Healthcare workers were more aware of CPR than lay respondents (96.5% vs 68.1%; p < 0.001). Eighty-five percent of respondents were aware that CPR involves chest compressions, and almost 70% indicated that "mouth to mouth" is a necessary component of CPR. Fewer than 10% were unwilling to administer CPR. Lack of skills (44.9%) and fear of causing harm (25.5%) were barriers noted by respondents for not administering CPR. Notably, a quarter of ambulance workers reported never having received CPR training. If they were to witness a collapse, 62.0% would call an ambulance, and 32.6% would hail a taxi. CONCLUSION The majority of participants are willing to perform CPR. Contextualized training that emphasizes hands-only CPR and builds participants' confidence may increase bystander willingness and engagement.
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Affiliation(s)
- Martina Anto-Ocrah
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA. .,Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
| | - Nick Maxwell
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jeremy Cushman
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Emmanuel Acheampong
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ruth-Sally Kodam
- Women and Children's Health Advocacy Group-Ghana (https://wachagghana.org/), Accra, Ghana
| | - Christopher Homan
- Department of Computer Sciences, Rochester Institute of Technology, Rochester, NY, USA
| | - Timmy Li
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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19
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Mitchell R, Phillips G, O'Reilly G, Creaton A, Cameron P. World Health Assembly Resolution 72.31: What are the implications for the Australasian College for Emergency Medicine and emergency care development in the Indo-Pacific? Emerg Med Australas 2020; 31:696-699. [PMID: 31559698 DOI: 10.1111/1742-6723.13373] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/18/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Rob Mitchell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Georgina Phillips
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Gerard O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Anne Creaton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,West Gippsland Healthcare Group, Melbourne, Victoria, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
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20
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Howard I, Cameron P, Wallis L, Castrén M, Lindström V. Understanding quality systems in the South African prehospital emergency medical services: a multiple exploratory case study. BMJ Open Qual 2020; 9:bmjoq-2020-000946. [PMID: 32439739 PMCID: PMC7247383 DOI: 10.1136/bmjoq-2020-000946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/24/2020] [Accepted: 05/01/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction In South Africa (SA), prehospital emergency care is delivered by emergency medical services (EMS) across the country. Within these services, quality systems are in their infancy, and issues regarding transparency, reliability and contextual relevance have been cited as common concerns, exacerbated by poor communication, and ineffective leadership. As a result, we undertook a study to assess the current state of quality systems in EMS in SA, so as to determine priorities for initial focus regarding their development. Methods A multiple exploratory case study design was used that employed the Institute for Healthcare Improvement’s 18-point Quality Program Assessment Tool as both a formative assessment and semistructured interview guide using four provincial government EMS and one national private service. Results Services generally scored higher for structure and planning. Measurement and improvement were found to be more dependent on utilisation and perceived mandate. There was a relatively strong focus on clinical quality assessment within the private service, whereas in the provincial systems, measures were exclusively restricted to call times with little focus on clinical care. Staff engagement and programme evaluation were generally among the lowest scores. A multitude of contextual factors were identified that affected the effectiveness of quality systems, centred around leadership, vision and mission, and quality system infrastructure and capacity, guided by the need for comprehensive yet pragmatic strategic policies and standards. Conclusion Understanding and accounting for these factors will be key to ensuring both successful implementation and ongoing utilisation of healthcare quality systems in emergency care. The result will not only provide a more efficient and effective service, but also positively impact patient safety and quality of care of the services delivered.
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Affiliation(s)
- Ian Howard
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden .,Division of Emergency Medicine, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Peter Cameron
- Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lee Wallis
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, Western Cape, South Africa.,Division of Emergency Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Maaret Castrén
- Department of Emergency Medicine and Services, Helsinki University, Helsinki, Finland
| | - Veronica Lindström
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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21
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Hansen K, Boyle A, Holroyd B, Phillips G, Benger J, Chartier LB, Lecky F, Vaillancourt S, Cameron P, Waligora G, Kurland L, Truesdale M. Updated framework on quality and safety in emergency medicine. Emerg Med J 2020; 37:437-442. [PMID: 32404345 PMCID: PMC7413575 DOI: 10.1136/emermed-2019-209290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Quality and safety of emergency care is critical. Patients rely on emergency medicine (EM) for accessible, timely and high-quality care in addition to providing a 'safety-net' function. Demand is increasing, creating resource challenges in all settings. Where EM is well established, this is recognised through the implementation of quality standards and staff training for patient safety. In settings where EM is developing, immense system and patient pressures exist, thereby necessitating the availability of tiered standards appropriate to the local context. METHODS The original quality framework arose from expert consensus at the International Federation of Emergency Medicine (IFEM) Symposium for Quality and Safety in Emergency Care (UK, 2011). The IFEM Quality and Safety Special Interest Group members have subsequently refined it to achieve a consensus in 2018. RESULTS Patients should expect EDs to provide effective acute care. To do this, trained emergency personnel should make patient-centred, timely and expert decisions to provide care, supported by systems, processes, diagnostics, appropriate equipment and facilities. Enablers to high-quality care include appropriate staff, access to care (including financial), coordinated emergency care through the whole patient journey and monitoring of outcomes. Crowding directly impacts on patient quality of care, morbidity and mortality. Quality indicators should be pragmatic, measurable and prioritised as components of an improvement strategy which should be developed, tailored and implemented in each setting. CONCLUSION EDs globally have a remit to deliver the best care possible. IFEM has defined and updated an international consensus framework for quality and safety.
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Affiliation(s)
- Kim Hansen
- Emergency Department, Prince Charles Hospital, Chermside, Queensland, Australia .,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Adrian Boyle
- Emergency Department, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
| | - Brian Holroyd
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Emergency Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Georgina Phillips
- Emergency Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Jonathan Benger
- Academic Department of Emergency Care, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lucas B Chartier
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Emergency Department, University Health Network, Toronto, Ontario, Canada
| | - Fiona Lecky
- Health Services Research, University of Sheffield, Sheffield, UK.,Emergency Department /TARN, Salford Royal Hospitals NHS Foundation Trust, Salford, UK
| | | | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Emergency Department, Alfred Hospital, Melbourne, Victoria, Australia
| | - Grzegorz Waligora
- Emergency Department, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland
| | - Lisa Kurland
- Medical Sciences, Orebro Universitet, Orebro, Sweden
| | - Melinda Truesdale
- Emergency Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Emergency Department, Royal Women's Hospital, Parkville, Victoria, Australia
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22
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Anto-Ocrah M, Cushman J, Sanders M, De Ver Dye T. A woman's worth: an access framework for integrating emergency medicine with maternal health to reduce the burden of maternal mortality in sub-Saharan Africa. BMC Emerg Med 2020; 20:3. [PMID: 31931748 PMCID: PMC6958725 DOI: 10.1186/s12873-020-0300-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 12/31/2019] [Indexed: 12/14/2022] Open
Abstract
Background Within each of the Sustainable Development Goals (SDGs), the World Health Organization (WHO) has identified key emergency care (EC) interventions that, if implemented effectively, could ensure that the SDG targets are met. The proposed EC intervention for reaching the maternal mortality benchmark calls for “timely access to emergency obstetric care.” This intervention, the WHO estimates, can avert up to 98% of maternal deaths across the African region. Access, however, is a complicated notion and is part of a larger framework of care delivery that constitutes the approachability of the proposed service, its acceptability by the target user, the perceived availability and accommodating nature of the service, its affordability, and its overall appropriateness. Without contextualizing each of these aspects of access to healthcare services within communities, utilization and sustainability of any EC intervention-be it ambulances or simple toll-free numbers to dial and activate EMS-will be futile. Main text In this article, we propose an access framework that integrates the Three Delays Model in maternal health, with emergency care interventions. Within each of the three critical time points, we provide reasons why intended interventions should be contextualized to the needs of the community. We also propose measurable benchmarks in each of the phases, to evaluate the successes and failures of the proposed EC interventions within the framework. At the center of the framework is the pregnant woman, whose life hangs in a delicate balance in the hands of personal and health system factors that may or may not be within her control. Conclusions The targeted SDGs for reducing maternal mortality in sub-Saharan Africa are unlikely to be met without a tailored integration of maternal health service delivery with emergency medicine. Our proposed framework integrates the fields of maternal health with emergency medicine by juxtaposing the three critical phases of emergency obstetric care with various aspects of healthcare access. The framework should be adopted in its entirety, with measureable benchmarks set to track the successes and failures of the various EC intervention programs being developed across the African continent.
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Affiliation(s)
- Martina Anto-Ocrah
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. .,Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | - Jeremy Cushman
- Division of Pre-Hospital Medicine, Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Mechelle Sanders
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Timothy De Ver Dye
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, USA
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23
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Chrusciel J, Fontaine X, Devillard A, Cordonnier A, Kanagaratnam L, Laplanche D, Sanchez S. Impact of the implementation of a fast-track on emergency department length of stay and quality of care indicators in the Champagne-Ardenne region: a before-after study. BMJ Open 2019; 9:e026200. [PMID: 31221873 PMCID: PMC6588991 DOI: 10.1136/bmjopen-2018-026200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the effect of the implementation of a fast-track on emergency department (ED) length of stay (LOS) and quality of care indicators. DESIGN Adjusted before-after analysis. SETTING A large hospital in the Champagne-Ardenne region, France. PARTICIPANTS Patients admitted to the ED between 13 January 2015 and 13 January 2017. INTERVENTION Implementation of a fast-track for patients with small injuries or benign medical conditions (13 January 2016). PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of patients with LOS ≥4 hours and proportion of access block situations (when patients cannot access an appropriate hospital bed within 8 hours). 7-day readmissions and 30-day readmissions. RESULTS The ED of the intervention hospital registered 53 768 stays in 2016 and 57 965 in 2017 (+7.8%). In the intervention hospital, the median LOS was 215 min before the intervention and 186 min after the intervention. The exponentiated before-after estimator for ED LOS ≥4 hours was 0.79; 95% CI 0.77 to 0.81. The exponentiated before-after estimator for access block was 1.19; 95% CI 1.13 to 1.25. There was an increase in the proportion of 30 day readmissions in the intervention hospital (from 11.4% to 12.3%). After the intervention, the proportion of patients leaving without being seen by a physician decreased from 10.0% to 5.4%. CONCLUSIONS The implementation of a fast-track was associated with a decrease in stays lasting ≥4 hours without a decrease in access block. Further studies are needed to evaluate the causes of variability in ED LOS and their connections to quality of care indicators.
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Affiliation(s)
- Jan Chrusciel
- Department of Medical Information and Performance Evaluation, Centre Hospitalier de Troyes, Troyes, France
- Department of Research and Public Health, University Hospitals of Reims, Reims, France
| | - Xavier Fontaine
- Emergency Department, Manchester Hospital, Charleville-Mézières, France
| | - Arnaud Devillard
- Emergency Department, Centre Hospitalier de Troyes, Troyes, France
| | - Aurélien Cordonnier
- Department of Medical Information, Manchester Hospital, Charleville-Mézières, France
| | - Lukshe Kanagaratnam
- Department of Research and Public Health, University Hospitals of Reims, Reims, France
- Faculty of Medicine, Université de Reims Champagne-Ardenne, Reims, France
| | - David Laplanche
- Department of Medical Information and Performance Evaluation, Centre Hospitalier de Troyes, Troyes, France
| | - Stéphane Sanchez
- Department of Medical Information and Performance Evaluation, Centre Hospitalier de Troyes, Troyes, France
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24
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Abstract
OBJECTIVE All healthcare systems require valid ways to evaluate service delivery. The objective of this study was to identify existing content validated quality indicators (QIs) for responsible use of medicines (RUM) and classify them using multiple frameworks to identify gaps in current quality measurements. DESIGN Systematic review without meta-analysis. SETTING All care settings. SEARCH STRATEGY CINAHL, Embase, Global Health, International Pharmaceutical Abstract, MEDLINE, PubMed and Web of Science databases were searched up to April 2018. An internet search was also conducted. Articles were included if they described medication-related QIs developed using consensus methods. Government agency websites listing QIs for RUM were also included. ANALYSIS Several multidimensional frameworks were selected to assess the scope of QI coverage. These included Donabedian's framework (structure, process and outcome), the Anatomical Therapeutic Chemical (ATC) classification system and a validated classification for causes of drug-related problems (c-DRPs; drug selection, drug form, dose selection, treatment duration, drug use process, logistics, monitoring, adverse drug reactions and others). RESULTS 2431 content validated QIs were identified from 131 articles and 5 websites. Using Donabedian's framework, the majority of QIs were process indicators. Based on the ATC code, the largest number of QIs pertained to medicines for nervous system (ATC code: N), followed by anti-infectives for systemic use (J) and cardiovascular system (C). The most common c-DRPs pertained to 'drug selection', followed by 'monitoring' and 'drug use process'. CONCLUSIONS This study was the first systematic review classifying QIs for RUM using multiple frameworks. The list of the identified QIs can be used as a database for evaluating the achievement of RUM. Although many QIs were identified, this approach allowed for the identification of gaps in quality measurement of RUM. In order to more effectively evaluate the extent to which RUM has been achieved, further development of QIs may be required.
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Affiliation(s)
- Kenji Fujita
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rebekah J Moles
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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