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Abiodun MT, Ochaba EA, Kpongo-Ogieva A. Bedside critical care training: A quasi-experimental study in the paediatric emergency department of a referral hospital in Nigeria. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2024; 40:e1141. [PMID: 38989479 PMCID: PMC11232563 DOI: 10.7196/sajcc.2024.v40i1.1141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 07/12/2024] Open
Abstract
Background There is a need for critical care services outside intensive care units (ICUs), especially in emergency departments (EDs). However, there is a paucity of skilled manpower for ED critical care or emergency critical care (ECC) in resource-limited settings. Objectives To evaluate the impact of bedside training on emergency critical care practices of clinical staff. Methods This was a quasi-experimental study using a pretest - post-test design in a paediatric ED. The intervention was a six-week structured bedside training on bubble continuous positive airway pressure (CPAP) high-flow nasal cannula (HFNC) and mechanical ventilation. Participants' actual ECC practices pre and post training were evaluated, including their perceived proficiency on an uncalibrated 100 mm visual analogue scale (VAS). Descriptive and inferential analyses were done; p<0.05 was considered significant. Results A total of 35 clinical staff participated in the training, comprising 9 (24.3%) paediatric registrars, 12 (32.5%) senior registrars, 10 (27.0%) nurses, 4 (10.8%) house officers and 2 (5.4%) paediatric consultants. The male:female ratio of the participants was 1:1.6, and their mean (SD) age was 33.24 (6.30 years. Participants' understanding of testing the CPAP circuit, connecting the patient and weaning significantly improved following training (p=0.004). Their capacity to select appropriate HFNC parameters improved (p=0.013). They performed more endotracheal intubations in the post-training period (p=0.001). Their pretest-post-test proficiency in mechanical ventilation increased on VAS (mean scores 45.26+31.99 v. 63.26+22.26; p=0.038). Also, there was a significant increase in their perceived proficiency in paediatric analgesia/sedation (30.83+29.86 v. 49.83+23.90; p=0.029). Conclusion Short-term bedside critical care training enhanced the self-reported competency of paediatric ED staff. There is a need for on-the-job ECC training and retraining of clinical staff in our setting. Contribution of the study Paediatric emergency department clinical staff desire hands-on critical care training in developing settings. Bedside training improves the knowledge and skills of nursing staff in non-invasive ventilation. Bedside training also builds the capacity of medical staff in invasive ventilation in the emergency department. Overall, short-term bedside training enhances the clinical knowledge and self-reported critical care practice of clinical staff in Children's Emergency Room.
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Affiliation(s)
- M T Abiodun
- Paediatric Emergency Division, Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
- Department of Child Health, School of Medicine, College of Medical Sciences, University of Benin, Benin City, Edo State, Nigeria
| | - E A Ochaba
- Paediatric Emergency Division, Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - A Kpongo-Ogieva
- Paediatric Emergency Division, Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
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Klazura G, Stephens C, Musinguzi E, Mugarura R, Nyonyintono J, Laverde R, Nimanya S, Situma M, Bua E, Yap A, Sims T, Ozgediz D, Kisa P. Pediatric Emergency Surgery Course in Uganda: Long-Term Follow-Up and Insights From Further Dissemination. J Surg Res 2024; 295:837-845. [PMID: 38194867 PMCID: PMC10922965 DOI: 10.1016/j.jss.2023.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 11/13/2023] [Accepted: 11/18/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Approximately 170 pediatric surgeons are needed for the 24 million children in Uganda. There are only seven. Consequently, general surgeons manage many pediatric surgical conditions. In response, stakeholders created the Pediatric Emergency Surgery Course (PESC) for rural providers, given three times in 2018-2019. We sought to understand the course's long-term impact, current pediatric surgery needs, and determine measures for improvement. METHODS In October 2021, we distributed the same test given in 2018-2019. Student's t-test was used to compare former participants' scores to previous scores. The course was delivered again in May 2022 to new participants. We performed a quantitative needs assessment and also conducted a focus group with these participants. Finally, we interviewed Surgeon in Chiefs at previous sites. RESULTS Twenty three of the prior 45 course participants re-took the PESC course assessment. Alumni scored on average 71.9% ± 18% correct. This was higher from prior precourse test scores of 55.4% ± 22.4%, and almost identical to the 2018-2019 postcourse scores 71.9% ± 14%. Fifteen course participants completed the needs assessment. Participants had low confidence managing pediatric surgical disease (median Likert scale ≤ 3.0), 12 of 15 participants endorsed lack of equipment, and eight of 15 desired more educational resources. Qualitative feedback was positive: participants valued the pragmatic lessons and networking with in-country specialists. Further training was suggested, and Chiefs noted the need for more trained staff like anesthesiologists. CONCLUSIONS Participants favorably reviewed PESC and retained knowledge over three years later. Given participants' interest in more training, further investment in locally derived educational efforts must be prioritized.
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Affiliation(s)
- Greg Klazura
- Department of Surgery, University of Illinois at Chicago, Loyola University Medical Center.
| | - Caroline Stephens
- University of California San Francisco, Center for Health Equity in Surgery and Anesthesia
| | | | | | | | - Ruth Laverde
- University of California San Francisco, Center for Health Equity in Surgery and Anesthesia
| | | | | | | | - Ava Yap
- University of California San Francisco, Center for Health Equity in Surgery and Anesthesia
| | - Thomas Sims
- Department of Surgery, University of Illinois at Chicago
| | - Doruk Ozgediz
- University of California San Francisco, Center for Health Equity in Surgery and Anesthesia
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Silvers R, Watters R, Van Meter J. Capacity building in low- and middle-income countries: The essentials of sustainable education programs. Nurse Pract 2022; 47:32-40. [PMID: 35877146 DOI: 10.1097/01.npr.0000841940.71824.f6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
ABSTRACT NPs are an essential resource in the organization and creation of capacity-building efforts to improve healthcare across the globe. There are limited data to guide the creation of effective supplementary education projects. Recent evidence highlights the essential components of sustainability, curriculum development, and program evaluation.
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Sigalet EL, Lufesi N, Dubrowski A, Haji F, Khan R, Grant D, Weinstock P, Wishart I, Molyneux E, Kissoon N. Simulation and Active Learning Decreases Training Time of an Emergency Triage Assessment and Treatment Course in Pilot Study in Malawi: Implications for Increasing Efficiency and Workforce Capacity in Low-Resource Settings. Pediatr Emerg Care 2021; 37:e1259-e1264. [PMID: 31990851 DOI: 10.1097/pec.0000000000001996] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the Emergency Triage Assessment and Treatment (ETAT) plus trauma course is to improve the quality of care provided to infants and children younger than 5 years. The curriculum was revised and shortened from 5 to 2.5 days by enhancing simulation and active learning opportunities. The aim of this study was to examine the feasibility and value of the new short-form ETAT course by assessing postcourse knowledge and satisfaction. METHODS We delivered the short-form ETAT course to a group of interdisciplinary health workers in Malawi. Precourse and postcourse knowledge was assessed using a standardized 20 questions short answer test used previously in the 5-day courses. A 13-statement survey with 2 open-ended questions was used to examine participant satisfaction. RESULTS Participants' postcourse knowledge improved significantly (P < 0.001) after the shorter ETAT course. Participants reported high levels of satisfaction with the short-form ETAT. CONCLUSIONS Simulation and other active learning strategies reduced training time by 50% in the short-form ETAT course. Participants with and without previous ETAT training improved their knowledge after participating in the short-form ETAT course. Reduced training time is beneficial in settings already burdened by scarce human resources, may facilitate better access to in-service training, and build capacity while conserving resources in low-resource settings.
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Affiliation(s)
| | | | - Adam Dubrowski
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada
| | - Faizal Haji
- Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL
| | - Rabia Khan
- The Wilson Centre for Research in Education, University of Toronto, Calgary, Alberta, Canada
| | - David Grant
- Bristol Medical Simulation Centre, Bristol, United Kingdom
| | | | - Ian Wishart
- Department of Emergency Medicine, Interprofessional Education Cumming School of Medicine, Calgary, Alberta, Canada
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Ullrich S, Kisa P, Ruzgar N, Okello I, Oyania F, Kayima P, Kakembo N, Sekabira J, Situma M, Ozgediz D. Implementation of a contextually appropriate pediatric emergency surgical care course in Uganda. J Pediatr Surg 2021; 56:811-815. [PMID: 33183745 DOI: 10.1016/j.jpedsurg.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Low- and middle-income countries like Uganda face a severe shortage of pediatric surgeons. Most children with a surgical emergency are treated by nonspecialist rural providers. We describe the design and implementation of a locally driven, pilot pediatric emergency surgical care course to strengthen skills of these providers. This is the first description of such a course in the current literature. METHODS The course was delivered three times from 2018 to 2019. Modules include perioperative management, neonatal emergencies, intestinal emergencies, and trauma. A baseline needs assessment survey was administered. Participants in the second and third courses also took pre and postcourse knowledge-based tests. RESULTS Forty-five providers representing multiple cadres participated. Participants most commonly perform hernia/hydrocele repair (17% adjusted rating) in their current practice and are least comfortable managing cleft lip and palate (mean Likert score 1.4 ± 0.9). Equipment shortage was identified as the most significant challenge to delivering pediatric surgical care (24%). Scores on the knowledge tests improved significantly from pre- (55.4% ± 22.4%) to postcourse (71.9% ± 14.0%, p < 0.0001). CONCLUSION Nonspecialist clinicians are essential to the pediatric surgical workforce in LMICs. Short, targeted training courses can increase provider knowledge about the management of surgical emergencies. The course has spurred local surgical outreach initiatives. Further implementation studies are needed to evaluate the impact of the training. LEVEL OF EVIDENCE V.
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Affiliation(s)
| | - Phyllis Kisa
- Mulago National Referral Hospital, Kampala, Uganda
| | - Nensi Ruzgar
- Yale University School of Medicine, New Haven, CT
| | | | - Felix Oyania
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | | | | | | | | | - Doruk Ozgediz
- University of California San Francisco, San Francisco, CA
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Bjorklund A, Slusher T, Day LT, Yola MM, Sleeth C, Kiragu A, Shirk A, Krohn K, Opoka R. Pediatric Critical Care in Resource Limited Settings-Lessening the Gap Through Ongoing Collaboration, Advancement in Research and Technological Innovations. Front Pediatr 2021; 9:791255. [PMID: 35186820 PMCID: PMC8851601 DOI: 10.3389/fped.2021.791255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022] Open
Abstract
Pediatric critical care has continued to advance since our last article, "Pediatric Critical Care in Resource-Limited Settings-Overview and Lessons Learned" was written just 3 years ago. In that article, we reviewed the history, current state, and gaps in level of care between low- and middle-income countries (LMICs) and high-income countries (HICs). In this article, we have highlighted recent advancements in pediatric critical care in LMICs in the areas of research, training and education, and technology. We acknowledge how the COVID-19 pandemic has contributed to increasing the speed of some developments. We discuss the advancements, some lessons learned, as well as the ongoing gaps that need to be addressed in the coming decade. Continued understanding of the importance of equitable sustainable partnerships in the bidirectional exchange of knowledge and collaboration in all advancement efforts (research, technology, etc.) remains essential to guide all of us to new frontiers in pediatric critical care.
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Affiliation(s)
- Ashley Bjorklund
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States.,Global Pediatric Program, Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Tina Slusher
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States.,Global Pediatric Program, Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Louise Tina Day
- Maternal and Newborn Health Group, Department of Infectious Disease Epidemiology, London School Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Clark Sleeth
- Department of Pediatrics, Tenwek Hospital, Bomet, Kenya
| | - Andrew Kiragu
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States.,Global Pediatric Program, Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States.,Childrens Hospital of Minnesota, Minneapolis, MN, United States
| | - Arianna Shirk
- Department of Pediatrics, Africa Inland Church Kijabe Hospital, Kijabe, Kenya
| | - Kristina Krohn
- Global Pediatric Program, Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States.,Department of Internal Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Robert Opoka
- Department of Pediatrics, Makerere University, Kampala, Uganda
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Losonczy LI, Barnes SL, Liu S, Williams SR, McCurdy MT, Lemos V, Chandler J, Colas LN, Augustin ME, Papali A. Critical care capacity in Haiti: A nationwide cross-sectional survey. PLoS One 2019; 14:e0218141. [PMID: 31194795 PMCID: PMC6565360 DOI: 10.1371/journal.pone.0218141] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/26/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Critical illness affects health systems globally, but low- and middle-income countries (LMICs) bear a disproportionate burden. Due to a paucity of data, the capacity to care for critically ill patients in LMICs is largely unknown. Haiti has the lowest health indices in the Western Hemisphere. In this study, we report results of the first known nationwide survey of critical care capacity in Haiti. DESIGN Nationwide, cross-sectional survey of Haitian hospitals in 2017-2018. SETTING Haiti. SUBJECTS All Haitian health facilities with at least six hospital beds. INTERVENTIONS Electronic- and paper-based survey. RESULTS Of 51 health facilities identified, 39 (76.5%) from all ten Haitian administrative departments completed the survey, reporting 124 reported ICU beds nationally. Of facilities without an ICU, 20 (83.3%) care for critically ill patients in the emergency department. There is capacity to ventilate 62 patients nationally within ICUs and six patients outside of the ICU. One-third of facilities with ICUs report formal critical care training for their physicians. Only five facilities met criteria for a Level 1 ICU as defined by the World Federation of Societies of Intensive and Critical Care Medicine. Self-identified barriers to providing more effective critical care services include lack of physical space for critically ill patients, lack of equipment, and few formally trained physicians and nurses. CONCLUSIONS Despite a high demand for critical care services in Haiti, current capacity remains insufficient to meet need. A significant amount of critical care in Haiti is provided outside of the ICU, highlighting the important overlap between emergency and critical care medicine in LMICs. Many ICUs in Haiti lack basic components for critical care delivery. Streamlining critical care services through protocol development, education, and training may improve important clinical outcomes.
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Affiliation(s)
- Lia I. Losonczy
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Emergency Medicine, George Washington University, Washington, District of Columbia, United States of America
| | - Sean L. Barnes
- Department of Decision, Operations & Information Technologies, Robert H. Smith School of Business, University of Maryland, College Park, Maryland, United States of America
| | - Shiping Liu
- Department of Mathematics, University of Maryland, College Park, Maryland, United States of America
| | - Sarah R. Williams
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Michael T. McCurdy
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Vivienne Lemos
- Taddle Creek Family Health Team, Toronto, Ontario, Canada
| | | | - L. Nathalie Colas
- Department of Internal Medicine, St. Luke Hospital, Port-au-Prince, Haiti
| | - Marc E. Augustin
- Department of Internal Medicine, St. Luke Hospital, Port-au-Prince, Haiti
| | - Alfred Papali
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Division of Pulmonary & Critical Care Medicine, Atrium Health, Charlotte, North Carolina, United States of America
- Division of Pulmonary & Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- * E-mail:
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Abstract
PURPOSE OF REVIEW Two-thirds of the world's population lacks access to surgical care, many of them being children. This review provides an update on recent advances in global children's surgery. RECENT FINDINGS Surgery is being increasingly recognized as an essential component of global and child health. There is a greater focus on sustainable collaborations between high-income countries (HICs) and low-and-middle-income countries (HICs and LMICs). Recent work provides greater insight into the global disease burden, perioperative outcomes and effective context-specific solutions. Surgery has continued to be identified as a cost-effective intervention in LMICs. There have also been substantial advances in research and advocacy for a number of childhood surgical conditions. SUMMARY Substantial global disparities persist in the care of childhood surgical conditions. Recent work has provided greater visibility to the challenges and solutions for children's surgery in LMICs. Capacity-building and scale up of children's surgical care, more robust implementation research and ongoing advocacy are needed to increase access to children's surgical care worldwide.
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