Quality of emergency medical care in Gondar University Referral Hospital, Northwest Ethiopia: a survey of patients' perspectives

[Validation of the SERVPERF tool for quality analysis in emergency care with clinical ultrasound]

OBJECTIVE

To analyze the reliability and validity of the SERVPERF questionnaire for assessing the quality of care from the patient's perspective in emergency departments for abdominal pain patients undergoing clinical ultrasound, as well as the influence of sex.

DESIGN

Prospective study from March 2023 to April 2024 involving patients treated for abdominal pain who underwent clinical ultrasound.

SETTING

Emergency department.

PARTICIPANTS

Adults over 18 years old with abdominal pain.

INTERVENTIONS

Conducting clinical ultrasound and collecting the adapted SERVPERF questionnaire.

MAIN MEASUREMENTS

Overall score of the questionnaire, sex, age, length of stay in the emergency department, referral origin, discharge destination, ultrasound results.

RESULTS

A total of 115 patients were included, with a mean age of 58.2 years (SD: 19.4) and 66.1% being women. To validate the questionnaire, the Bartlett's test of sphericity yielded a value of 0.000 (P<.05) and the KMO (Kaiser-Meyer-Olkin) test resulted in a value of 0.855 (>0.5). The reliability of the questionnaire was assessed using Cronbach's alpha: 0.928 (95% CI: 0.908-0.946). The mean score on the scale was 124.57±9.30. Men showed a higher overall mean score than women, approaching statistical significance (P=.05). Using multiple linear regression, no variable was independently associated with a higher perception of quality in care, although sex was marginally significant.

CONCLUSIONS

The SERVPERF questionnaire is shown to be reliable and valid for determining the perceived quality of service. Additionally, the perceived quality of care using clinical ultrasound in the emergency department was very high. No differences based on sex were observed.

Prevalence and associated factors of depression among women with advanced pelvic organ prolapse in Northwest Ethiopia: cross-sectional study

BACKGROUND

Depression is a symptom characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration. One of the most common mental illnesses in the world and a major contributor to morbidity and mortality is depression. The purpose of this study was to ascertain the prevalence of depression and the risk factors associated with it in women who had advanced pelvic organ prolapse.

METHODS

A facility-based cross-sectional study was conducted to determine depression among advanced pelvic organ prolapse women at Gondar University Comprehensive Specialized Hospital. All women who have advanced pelvic organ prolapse were consecutively included till it reached a total of 367 participants over four months. A structured questionnaire was used to obtain the sociodemographic characteristics, clinical characteristics and depression status of the participants. Depression measures were obtained by using the Patient Health Questionnaire tool, which is validated in the Ethiopian local language for chronic illnesses including pelvic organ prolapse using a cut point of five and above, which is considered to indicate depression. Women who screened positive were linked to a psychiatric clinic for further evaluation and treatment. Data was entered into a computer using Epi Info version 3.5.3 and then exported to STATA version 14 for analysis. Multivariable logistic regressions were fitted and odds ratios with 95% confidence intervals with a P value less than 0.05 were used to identify statistically significant factors.

RESULTS

The prevalence of depression was found to be 47.1% (95% CI: 43-52%). Being rural (AOR = 4.8; CI: 1.11-16.32), having a history of divorce because of pelvic organ prolapse (AOR = 5.5; CI: 1.85-16.32) and having a history of urinary symptoms (AOR = 3.1; CI: 1.12-8.59) were found to be independently associated with depression.

CONCLUSIONS

The prevalence of depression among women with advanced pelvic organ prolapse in this study is high as compared to other studies. Depression screening strategies should be designed for the early identification and treatment of depression among women with advanced pelvic organ prolapse.

Time to develop adverse drug reactions and associated factors among children HIV positive patients on antiretroviral treatment in North West Amhara Specialized Hospitals: Retrospective cohort study, 2022

Introduction

Adverse drug reactions (ADRs) are harmful and unintended reactions to medicines given at standard doses through a proper route of administration for the purpose of prophylaxis, diagnosis, or treatment.

Objective

The objective of this research paper was to assess median time to development of ADRs and associated factors among children HIV positive patients on antiretroviral treatment (ART) in North West Amhara Specialized Hospitals.

Methods

The adverse drug effect survival time was estimated using the Kaplan-Meier survival method and log-rank test curves was applied for analyze "time-to-event" data. Cox regression model was used to identify the associated factors. Adjusted hazard ratios with their respective 95% confidence intervals (CIs) were estimated and a value of p less than 0.05 was used to declare the presence of a significant association.

Result

The overall incidence of ADRs was 0.67 (95% CI: 3.74-4.44) per 10,000 person-year observation, with a median of 57 months. Adults are presenting with opportunistic Infections (OIs) experiences, baseline CD4 < 200 cells/µL counts, 1e, tenofovir disoproxil fumarate-lamivudine-efavirenz ART regimen, bedridden baseline functional status, World Health Organization (WHO) clinical stage II and III were notably associated with the incidence of ADRs development.

Conclusion

ADRs were uncommon in this study. predictors, such as OIs experiences, a low CD4 count, ART regimen, an advanced WHO stage, and bedridden functional status were significantly associated with ADRs.

Willingness to pay for medical care and its determinants in private health care facilities among Gondar city residents, Northwest Ethiopia: Cross sectional study

Medical care is a type of health service that mainly consists of investigation and diagnosis, treatment, rehabilitative care, and nursing care for the purpose of maintaining the structure or function of the body. A medical care payment is a sort of payment made for the diagnosis, cure, mitigation, treatment, or prevention of disease, sickness, or damage, which includes checkups and periodic exams. In low-income nations, out-of-pocket expenditures account for 60 % of overall health spending, compared to 20 % in high-income ones. Willingness to pay is perhaps the highest money that a person is willing to provide to ensure that a particular wellbeing care action is undertaken. Previous research works focused mainly on the patients' willingness to pay but not the amount they can afford. The focus of this study is to determine the level of willingness to pay, the mean amount of willingness to pay for medical care, and its major determinants. A community-based cross-section study was carried out among Gondar city residents from February 2022 to March 2022. The study participants were recruited by systematic random sampling. Four data collectors conducted interviews using a questionnaire. For analysis, the dataset was entered into Epi Info version 7 and transferred to STATA version 14. The descriptive part was summarized using summary statistics like mean, median, and standard deviation. Determinants of willingness to pay were identified using a Tobit regression model with a significance of p-value ≤ 0.05 and confidence interval (CI ≠ 0). Finally, the analyzed data was presented using tables and figures accordingly. The study involved 414 participants, with a response rate of 95.8 %. About 53.62 % of the participants were willing to pay for medical care and the average willingness to pay was 24.17 USD per year. They were more willing to pay if they were still working (β = 19.66), currently married (β = 14.49), had a family history of medical care (β = 25.74), had good knowledge (β = 36.16), had a history of medical illness (β = 16.64), lived a long distance from the health facility (β = 1.98), and had a high wealth index (β = 29.51). The willingness to pay for medical care is below the actual cost. Designing a cost-recovery strategy with multi-tiered programs assigned to the most vulnerable individuals, such as the elderly, less educated, or seriously sick, is a strategic approach of the raising demand for service uptake and accessibility.

Assessment patient satisfaction towards emergency medical care and its determinants at Ayder comprehensive specialized hospital, Mekelle, Northern Ethiopia

BACKGROUND

As the healthcare industry shifts toward patient-centered models, providers will need to fully understand patient satisfaction and how they affect their practices. This study aimed to assess patient satisfaction towards the emergency medical care and factors associated with at Ayder specialized comprehensive hospital, Emergency room, Mekelle, Ethiopia.

METHODS

An institution-based cross-sectional study was conducted from March 1-30, 2019. A systematic random sampling method was used to enroll 299 study participants. Data were collected using a standard Brief Emergency Department Patient Satisfaction Scale questionnaire by trained data collectors. Data was entered into EpiData 3.1 then exported and analyzed by SPSS version 22. Binary and multiple logistic regression were used to assess the factors associated with patient satisfaction. Where the p-value of <0.05 was considered significant.

RESULTS

A total of 299 participants were enrolled in the study with a response rate of 99.3%. On overall patient satisfaction score majority (81.9%) of them were satisfied with the emergency medical care provided. The satisfaction rate towards emergency staff courtesy, emergency room environment, physician care satisfaction, general patient satisfaction, and patient family satisfaction was 80.3%, 37.5%, 75.9%, 70.9%, and 49.8% respectively. Those who arrived during the morning time of the day tend to be satisfied more with the emergency services (AOR = 4.8, 95% CI: 2.08, 11.4), while having low educational status (able to read and write) (AOR = 0.12, 95% CI: 0.03, 0.50) and waiting time till seen by a doctor (AOR = 1.3, 95% CI: 1.003, 1.4) was found to affect patient satisfaction negatively.

CONCLUSIONS

The total patient satisfaction score towards emergency medical care was found to be good. The hospital management and emergency room staff should act on the identified factors especially on minimizing the patients waiting time to improve the quality of care in the emergency department.

Spectrum, Pattern, and Clinical Outcomes of Adult Emergency Department Admissions in Selected Hospitals of Western Ethiopia: A Hospital-Based Prospective Study

Background

There has been a steady rise in the absolute number of emergency room admissions over the last few decades. The healthcare delivery system of a country is required to be adjusted to patterns of morbidity and mortality to mitigate the minimized prolonged ill health consequences and premature death of adults. The spectrum, patterns, morbidity, and mortality of health and health-related emergency conditions for which patients visit hospitals often reflect the magnitude of different health problems in a society. The objective of this study was therefore to assess the spectrum, pattern, characteristics, and clinical outcomes of emergency department admissions among adult people who visited EDs of the selected hospitals in western Ethiopia.

Methodology

Hospital-based prospective cross-sectional study design was utilized. To select hospitals to be included in the study, the area sampling technique was used. Five administrative zones in west Oromia were selected as geographical clusters. Then, four hospitals were randomly selected from each zone. Finally, the consecutive sampling technique was utilized to recruit the study participants.

Results

The mean age of the patients admitted to emergency departments (EDs) of the selected hospitals was 34.98 years. The male-to-female ratio of the respondents was nearly equal (1 : 1.04). While one-fourth (20.4%) of the patients arrived by ambulances (without identifying reason), 23.6% of them visited the emergency department as they had no other place to go. Medical emergencies (45.4%) were the leading types of emergencies followed by traumatic emergencies (27.3%). Respiratory distress (12.43%), extremity fractures (9.61%), and hypertensive disorders (8.6%) were among the top leading causes of adult ED admissions. Vital signs were deranged in about 59.4% of the cases. The most common type of immediately life-threatening problems identified on arrival was impairment of breathing (37%), followed by circulatory compromises (30%). Emergency department admission patterns were variable with peak admissions in the month of February and the lowest in November. The vast majority (90.9%) of emergency patients survived. While 8.5% of patients died of the various types of emergency conditions, the final clinical outcome was not identified in 1.5% of the patients.

Conclusion

This study has showed mixed cases with varied patterns and outcomes of adult emergency department admissions. As overall there is a need to be alert during specific seasons, actions must be taken to improve the readiness of existing emergency room services. Furthermore, it is worthwhile to invest further on standardizing and organizing prehospital services at the community level.

Pattern of surgical emergencies in a Nigerian tertiary hospital

BACKGROUND

Surgical emergencies account for a major part of the surgeon's workload. Evaluation of pattern of surgical emergencies will assist in developing concrete proposals for improved care. The aim was to assess the pattern of surgical emergencies in our center.

METHODS

We undertook one-year prospective study of all the emergency surgical admissions at Federal Medical Centre Makurdi from January to December 2011.

RESULTS

There were 575 surgical emergencies which constituted 56.8% of surgical admission, and 27.2% of allemergency hospital admissions. The commonest trauma cases were soft tissue injuries (30.3%), while the commonest non-trauma case was acute abdomen (41.6%). The mean age of the patients was 33.7 ± 17.2 years. Multiple injuries and traumatic brain injuries requiring intensive care monitoring, and malignancies were associated with higher mortality rates (p = 0.001). The 1-year mortality rate was 7.8% and the preventable death rate (PDR) for the trauma-related emergencies was 71.4%.

CONCLUSION

There is a wide spectrum of surgical emergencies in our setting with trauma accounting for a substantial proportion of cases. Improved trauma care, neurosurgical services and intensive care facilities may improve the outcome of surgical emergencies in our environment.

The burden on emergency centres to provide care for critically ill patients in Addis Ababa, Ethiopia

Introduction

Given the scarcity of critical care hospital beds in Africa, emergency centres (ECs) are increasingly charged with caring for critically ill patients for extended periods of time. The objective of this study was to improve the understanding of the nature and outcomes of critically ill patients with prolonged treatment times of more than six hours in two ECs in Addis Ababa, Ethiopia.

Methods

This study was conducted over three months in two ECs of urban tertiary care hospitals in Addis Ababa. Structured questionnaires were completed by six emergency and critical care nurses. EC patients were included if they met the Society for Critical Care Medicine (SCCM) intensive care unit (ICU) admission criteria and stayed in the EC for more than 6 h. We collected initial demographic and clinical information, data about the patients’ clinical course in the EC, and data regarding the patients’ disposition. We used descriptive statistics for analysis.

Results

A total of 291 patients, over the course of three months, had an EC stay that exceeded six hours. The median length of stay for these patients was 48 h (interquartile range: 25–72 h). The most common categories of illness were neurological disease in 87 patients (30%) and cardiovascular disease in 61 patients (21%). The most frequent aetiologies of critical illness were severe head trauma and severe sepsis with multi-organ failure (26 patients, 9% each). A total of 94 patients (32%) died in the EC, while 86 (30%) were discharged directly from the EC without hospital admission.

Discussion

ECs in Addis Ababa face a heavy burden in caring for a large number of critically ill patients over a long period of time, with relatively high mortality rates. These findings should promote supporting emergency centres to strengthen and expand ICU capacity to provide appropriate critical care services.

Epidemiological and clinical features of the emergency visits in a rural hospital in Cubal, Angola

Introduction

There is scarce information on the profiles of patients attended in the Emergency Departments (ED) in rural Angola.

Methods

Retrospective descriptive study including all the patients treated in the ED in Hospital Nossa Senhora da Paz (Cubal) during 6 months (December 2014- May 2015). The epidemiological and clinical data collected were: age, sex, shift, service assignment, reason for consultation and outcome (discharge, admission, referral or death).

Results

A total of 2384 patients (53.4% women) were attended. The median age was 10 years (range: 0 - 96 years); 57.9% and 40.2% of them were under 17 and 5 years, respectively. No differences were observed regarding the assistance per shift, weekdays, weekends, or mean age per shift. The reason for consultation was registered in 69.9% of the patients; the most common were respiratory tract infections (20.5%), fever (14%), digestive diseases (13.6%) and malaria (10.4%). Up to 47.2% of the patients required in-hospital treatment and 1.3% were transferred to other hospitals. The patients admitted were significantly younger than the patients discharged (median age of 4 vs.16 years, p < 0.01). The mortality rate within the ED was 0.5%.

Conclusion

Young patients were those who mostly required assistance in the ED. Infectious diseases were the most frequent reason for consultation. Pulmonary tuberculosis was suspected in one third of respiratory infections. The admission rate was high, especially in children under 5 years and in cases of malaria and malnutrition. Low referral rate and low mortality within the ED were observed.

The clinical practice of emergency medicine in Mahajanga, Madagascar

Introduction

Little is documented concerning the clinical practice of emergency care in low- and middle-income countries. The lack of structural models presents serious obstacles to the development of effective emergency care services. This study provides such a model by describing the clinical practice at the emergency centre of the Centre Hôpitalier Universitaire de Mahajanga in Madagascar.

Methods

This was a retrospective chart review of all adult patients presenting to the emergency centre from September to November 2012. Archived chart data were extracted into a computer database. Data included: age, sex, date, diagnostic investigations, procedures, medications, and diagnosis.

Results

727 charts were reviewed, averaging eight patients per day. The three most frequent pathologies observed were trauma, gastrointestinal, and infectious disease. A total of 392 received diagnostic investigations. These were chiefly complete blood counts (n = 218), blood glucose (n = 155) and ECG (n = 92). Chest X-rays (n = 83), extremity X-rays (n = 55) and skull/face X-rays (n = 44) comprised the most common imaging. Ultrasounds were primarily abdominal (n = 9), renal/genitourinary (n = 6), and obstetric (n = 2). Therapeutic interventions were performed in 564 patients, most commonly intravenous access (n = 452) and wound/orthopaedic care (n = 185). Medications were administered to 568 patients, mostly anti-inflammatory/analgesics (n = 463) and antibiotics (n = 287).

Conclusion

This is the first descriptive study of the clinical practice of emergency medicine in Mahajanga, Madagascar. It provides both the Malagasy and international medical communities with an objective analysis of the practice of emergency care in Madagascar from both diagnostic and therapeutic standpoints. Emergency care here focuses on the management of traumatic injury and infectious disease. The diagnostic imaging, pharmacologic and procedural therapeutic interventions reflect the burdens placed upon this institution by these diseases. We hope this study will provide guidance for the further development of Malagasy-specific emergency care systems.