Impact of an emergency department nursing intervention on continuity of care, self-care, and psychological symptoms

BACKGROUND The emergency department plays a crucial role in providing acute care to patients.Nursing interventions in this setting are essential for improving the continuity of care,enhancing patients’self-care abilities,and reducing psychological symp-toms.AIM To evaluate the effect of nursing interventions in the emergency department on these indicators in an emergency department.METHODS A retrospective analysis was conducted on 120 patients admitted to the emergency department between January 2022 and May 2023.The patients were divided into two groups:The control group(conventional nursing intervention)and the observation group(conventional nursing intervention+emergency department nursing intervention).The two groups were compared regarding continuity of care,self-care ability,psychological symptoms,and satisfaction with care.RESULTS The emergency department nursing interventions significantly improved the continuity of care,enhanced patients’self-care abilities,and reduced psycho-logical symptoms such as anxiety and depression.CONCLUSION Nursing interventions in the emergency department positively impact continuity of care,self-care,and psychological symptoms.However,it is important to acknowledge the limitations of this study,including the small number of studies,variable methodological quality,and the heterogeneity of the study population.Future research should address these limitations and further explore the effects of different types of nursing interventions in the emergency department.Additionally,efforts should be made to enhance the application and evaluation of these interventions in clinical practice.

Systemic analysis of pre-hospital trauma emergency treatment in Zhengzhou

Objective: To analyze the data of pre-hospital emergency treatment in zhengzhou from 2007 to 2016, and evaluate the current situation of pre-hospital trauma emergency treatment, in order to provide a scientific basis for effective use of first aid resources and enhance success rate of trauma emergency treatment. Methods: Retrospective analysis was conducted based on pre-hospital emergency resources of Zhengzhou Emergency Medical Rescue Center from 2007 to 2016. Results: The total number of pre-hospital emergency treatment cases was 9305687 from 2007 to 2016 in Zhengzhou, of which 418882 were trauma cases. The top five causes of injury were traffic accident injury, cutting injury, beating injury, crushing injury and falling injury. The top five emergency treatments used were oxygen, hemostasis, dressing and fixation, fluid supplementation, analgesics and sputum aspiration. According to different directions of diagnosis, the pre-hospital emergency patients were divided into four groups:emergency treatment group, emergency observation group, admission to general ward group and admission to ICU group. There was no statistical difference in the ages among the four groups (P>0.05). There were significantly statistical differences in gender composition among the four groups, with more males than females (P<0.01). Significant statistical differences also showed in CRAMS scores among the four groups (P<0.01). Before and after the training of primary trauma care, there was no significant difference in the constituent ratio of the trauma (P>0.05), but the mortality of the trauma, the average arrival time, and the mean treatment time were significantly different (P<0.01). Conclusions: The number of pre-hospital emergency trauma patients increased year by year, but the constituent ratio changed little. CRAMS score is important for the patients triage. Through the training of primary trauma care, the constituent ratio of death was reduced, and the average treatment time was shortened.

Availability and Quality of Emergency Obstetric Care, an Alternative Strategy to Reduce Maternal Mortality: Experience of Tongji Hospital, Wuhan, China

The burden of maternal mortality (MM) and morbidity is especially high in Asia.However,China has made significant progress in reducing MM over the past two decades,and hence maternal death rate has declined considerably in last decade,To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital,Wuhan,China,this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009.Two baseline periods of equal length were used for the comparison of variables.A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations,either 71.35％ of all activities.No maternal death was recorded.Mean age of women was 29.31 years with a wide range of 14-52 years.About 96.26％ of women had higher levels of schooling,university degrees and above and received the education of secondary school or college.About 3.74％ received primary education at period two (P2) from 2005 to 2009,which was significantly higher than that of period one (P1) from 2000 to 2004 (P＜0.05) (OR:0.586; 95％ CI:0.442 to 0.776).About 65.69％ were employed as skilled or professional workers at P2,which was significantly higher than that of P1 (P＜0.05).About 34.31％ were unskilled workers at P2,which was significantly higher than that of P1 (P＜0.05).Caesarean section was performed for 9,930 women (88.48％) and the percentage of the procedure increased significantly from 19.25％ at P1 to 69.23％ at P2 (P＜0.05).We were led to conclude that,despite the progress,significant gaps in the performance of maternal health services between rural and urban areas remain.However,MM reduction can be achieved in China.Priorities must include,but not limited to the following:secondary healthcare development,health policy and management,strengthening primary healthcare services.

Validating a point of care lactate meter in adult patients with sepsis presenting to the emergency department of a tertiary care hospital of a low-to middle-income country

BACKGROUND: Timely identifi cation of high blood lactate levels in septic patients may allow faster detection of those patients requiring immediate resuscitation. Point-of-care(POC) testing is being increasingly utilized in the emergency department(ED). We examined the accuracy and timesaving effect of a handheld POC lactate device for the measurement of fingertip and whole blood lactate as compared with reference laboratory blood testing in septic ED patients.METHODS: A convenience sample of adult ED patients receiving serum lactate testing were enrolled prospectively in the ED of a multidisciplinary tertiary care hospital serving the population of one of the major cities of Pakistan. Participants underwent fi ngertip POC lactate measurement with a portable device and simultaneous whole blood sampling for analysis by both the POC lactate device and standard laboratory method. Lactate measurements were compared by intraclass correlation(ICC) and Bland and Altman plots.RESULTS: Forty-three septic patients were included in the study. The fingertip POC & whole blood POC lactate measurements each correlated tightly with the reference method(ICC=0.93 & ICC=0.92, respectively). Similarly at 6 hours, the fingertip POC & whole blood POC lactate measurements demonstrated satisfactory correlation with the reference method(ICC=0.95 & ICC=0.97, respectively).CONCLUSION: Fingertip POC lactate measurement is an accurate method to determine lactate levels in septic ED patients.KEY WORDS: Sepsis; Point of care; Lactate; Emergency department;

Acute care needs in an Indian emergency department： A retrospective analysis

BACKGROUND: Emergencies such as road traffic accidents(RTAs), acute myocardial infarction(AMI) and cerebrovascular accident(CVA) are the most common causes of death and disability in India. Robust emergency medicine(EM) services and proper education on acute care are necessary. In order to inform curriculum design for training programs, and to improve the quality of EM care in India, a better understanding of patient epidemiology and case burden presenting to the emergency department(ED) is needed.METHODS: This study is a retrospective chart review of cases presenting to the ED at Kerala Institute of Medical Sciences(KIMS), a private hospital in Trivandrum, Kerala, India, from November 1, 2011 to April 21, 2012 and from July 1, 2013 to December 21, 2013. De-identified charts were systematically sampled and reviewed.RESULTS: A total of 1 196 ED patient charts were analyzed. Of these patients, 55.35%(n=662) were male and 44.7%(n=534) were female. The majority(67.14%, n=803) were adults, while only 3.85%(n=46) were infants. The most common chief complaints were fever(21.5%, n=257), renal colic(7.3%, n=87), and dyspnea(6.9%, n=82). The most common ED diagnoses were gastrointestinal(15.5%, n=185), pulmonary(12.3%, n=147), tropical(11.1%, n=133), infectious disease and sepsis(9.9%, n=118), and trauma(8.4%, n=101).CONCLUSION: The patient demographics, diagnoses, and distribution of resources identifi ed by this study can help guide and shape Indian EM training programs and faculty development to more accurately refl ect the burden of acute disease in India.

Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia

BACKGROUND: Hospital emergency department(ED) use by patients from residential aged care facilities(RACFs) is not always appropriate, and this calls for interventions to avoid some unnecessary uses. This study aims to compare patterns of ED use by RACF patients with and without a Hospital in the Nursing Home(Hi NH) program.METHODS: RACF patients presenting to EDs of a hospital with and a hospital without this program during pre- and post-intervention periods were included. Data on patient demographics and ED presentation characteristics were obtained from the Emergency Department Information System database, and were analysed by descriptive and comparative statistics.RESULTS: In both hospitals, most RACF residents presenting to EDs were aged between 75–94 years, female, triaged at scale 3 to 5, and transferred on weekdays and during working hours. Almost half of them were subsequently admitted to hospitals. In accordance with the ICD-10-AM diagnostic coding system, diagnoses that consistently ranked among the top three reasons for visiting the two hospitals before and after intervention included Chapter XIX: injury and poisoning and Chapter X: respiratory diseases. Associated with the intervention, significant decreases in the numbers of presentations per 1 000 RACF beds were identified among patients diagnosed with Chapter XI: digestive diseases [rate ratio(95%CI): 0.09(0.04, 0.22); P<0.0001] and Chapter XXI: factors influencing health status and contact with health services [rate ratio(95%CI): 0.22(0.07, 0.66); P=0.007].CONCLUSION: The Hi NH program may reduce the incidence of RACF residents visiting EDs for diagnoses of Chapter XI and Chapter XXI.

Utility of point-of-care musculoskeletal ultrasound in the evaluation of emergency department musculoskeletal pathology

BACKGROUND: To evaluate the utilization of point-of-care ultrasound(POCUS) for the assessment of emergency department(ED) patients with musculoskeletal symptoms and the impact of musculoskeletal POCUS on medical decision-making and patient management in the ED.METHODS: This was a retrospective review of ED patients presenting with musculoskeletal symptoms who received a POCUS over a 3.5-year period. An ED POCUS database was reviewed for musculoskeletal POCUS examinations used for medical decision-making. Electronic medical records were then reviewed for demographic characteristics, history, physical examination findings, ED course, additional imaging studies, and impact of musculoskeletal POCUS on patient management in ED. RESULTS: A total of 264 subjects(92 females, 172 males) and 292 musculoskeletal POCUS examinations were included in the fi nal analysis. Most common symptomatic sites were knee(31.8%) and ankle(16.3%). Joint effusion was the most common fi nding on musculoskeletal POCUS, noted in 33.7% of the patients, and subcutaneous edema/cobblestoning was found in 10.2% of the patients. Muscle or tendon rupture was found in 2.3% of the patients, and 1.9% of the patients had joint dislocation. Bursitis or bursa fluid was found in 3.4% of patients, and tendonitis/tendinopathy was found in 2.3%. Twenty percent of them were ultrasound-guided musculoskeletal procedures, and most of them(73.3%) were arthrocentesis. Of the included studies, all except three either changed or helped guide patient management as documented in the patients' medical records.CONCLUSION: Our study fi ndings illustrate the utility of POCUS in the evaluation of a variety of musculoskeletal pathologies in the ED.

Integrating palliative care in oncologic emergency departments:Challenges and opportunities

Although visiting the emergency departments(EDs) is considered poor quality of cancer care,there are indications these visits are increasing.Similarly,there is growing interest in providing palliative care(PC) to cancer patients in EDs.However,this integration is not without major challenges.In this article,we review the literature on why cancer patients visit EDs,the rates of hospitalization and mortality for these patients,and the models for integrating PC in EDs.We discuss opportunities such integration will bring to the quality of cancer care,and resource utilization of resources.We also discuss barriers faced by this integration.We found that the most common reasons for ED visits by cancer patients are pain,fever,shortness of breath,and gastrointestinal symptoms.The majority of the patients are admitted to hospitals,about 13% of the admitted patients die during hospitalization,and some patients die in ED.Patients who receive PC at an ED have shorter hospitalization and lower resource utilization.Models based solely on increasing PC provision in EDs by PC specialists have had modest success,while very limited ED-based PC provision has had slightly higher impact.However,details of these programs are lacking,and coordination between ED based PC and hospitalwide PC is not clear.In some studies,the objectives were to improve care in the communities and reduce ED visits and hospitalizations.We conclude that as more patients receive cancer therapy late in their disease trajectory,more cancer patients will visit EDs.Integration of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer patients.PC specialist should play an active role in educating ED physicians about PC,and provide timely consultations.The impact of integrating PC in EDs on quality and cost of cancer care should be studied.

Study of the Conditions Surrounding Fatigue That Are Common to Medical Professionals Working in Emergency and Critical Care Centers in Japan

This study aimed to clarify the conditions surrounding fatigue that are common to medical professionals working in emergency and critical care centers in Japan. Semi-structured interviews were conducted with eight professionals ranging from doctors, nurses and pharmacists to clinical engineering technologists and radiation technologists. Their narratives were analyzed using the qualitative descriptive approach to determine fatigue common to all professionals and the reasons behind it. The five categories that emerged as the reasons for fatigue common to the subjects were [playing one’s role in treatment and procedures for emergency and critical patients], [accommodating the patient’s background and coming to terms with the outcome], [difficulties in liaising with other professionals], [feeling pressure as a responsible professional in emergency care] and [loss of sense of time caused by variable working hours]. The results revealed that fatigue common to all of the subjects was related to dealing with patients, coordinating with other professionals, having professional responsibilities and the working environment. This study suggests that arrangements to improve the working environment, ensure adequate staffing, and provide mental health support for the well-being of medical professionals working in emergency and critical care centers are necessary.

Point of care ultrasonography as the new“Laennec Sthetoscope”

Point of care ultrasonography(POCUS)has evolved to become the fifth pillar of the conventional physical examination,and use of POCUS protocols have significantly decreased procedure complications and time to diagnose.However,lack of experience in POCUS by preceptors in medical schools and nephrology residency programs are significant barriers to implement a broader use.In rural and low-income areas POCUS may have a transformative effect on health care management.

Clarifying Problems with Emergency Healthcare Systems in Japanese Long-Term Care Facilities for Older People

Background: Long-term care facilities for older people play an important role as alternatives to family care in an aging society. This study aimed to assess staffing problems linked to emergency healthcare for residents of these facilities, and to investigate the relationship between these problems and the characteristics of the facilities. Methods: The study surveyed managers of long-term care facilities for older people in a Japanese urban area between September and December 2014. The type of care facility, the number of staff and any problems providing or accessing emergency healthcare for the residents were evaluated. Multiple logistic regression analysis was used to explore the factors common to facilities reporting staffing problems linked to emergency healthcare of residents. Results: In total, 321 long-term care facilities were eligible for this study and 226 (70%) returned the questionnaire. We compared the characteristics of facilities reporting and not reporting staffing problems in emergency healthcare of residents. The type of care facility was significantly associated with staffing problems in emergency healthcare of residents both during the day (p < 0.01) and at night (p = 0.04). The facilities most likely to report problems were group homes for older people with dementia, because of staffing shortages. Conclusions: Problems in emergency healthcare systems in Japanese long-term care facilities for older people varied by type of care facility. Our data underscore the need for telemedicine and consideration of mergers between smaller facilities such as group homes for older people with dementia.

Retrospective Cohort Study on Acute Care in Obstetrics and Gynecology: Analogies and Differences When Compared to Emergency Medicine

Introduction: the demand for urgent obstetric and gynecology care has progressively increased: in the United States approximately 1.4 million gynecologic visits are made to the emergency department (ED) annually, while almost 75% of women make at least 1 unscheduled visit during pregnancy. Moreover, research has recently focused on setting standards in unscheduled care, and developing quality indicators to improve patients’ health. Therefore, we investigated the characteristics of women with acute gynecological or pregnancy complaints using quality indicators developed for emergency medicine, to better define the needs of this population and improve care. Methods: Retrospective cohort study on ED, and Obstetrics and Gynecology (ObGyn) triage visits, at a tertiary care hospital in Italy, during 2012. Data were analyzed with population-averaged logistic regression and Poisson regression. Results: When compared to the 33,557 ED visits, the 9245 ObGyntriage referrals were more frequently associated with pregnancy (≤12 weeks’ gestation, OR: 30.7, 95%CI;24.5 - 38.4;>12 weeks’ gestation, OR 81.2, 95%CI;64.8 - 101.4), vaginal bleeding (OR 156.6, 95%CI;82.7 - 294.4), diurnal (night access OR 0.87, 95% CI;0.78 - 0.96) and weekday access (holiday access OR 0.87, 95%CI;0.78 - 0.95), frequent users (recurrent ED visits IRR 0.87, 95%CI;0.83 - 0.9) and lower hospital admissions (ED admission OR 1.6, 95%CI;1.4 - 1.8). Conclusion: ObGyn triage patients differed from ED users, and were at higher risk of “crowding”. Such diversities should be considered to improve female healthcare services and allocate resources more efficiently.

A Scale of Parental Anxiety about Pediatric Emergency Medical Care Services of Japan: Development, Reliability, Validity, Generalizability and Usefulness

Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 parents with children 6 years old or younger in Kagawa Prefecture. Using each half of the participants, exploratory factor analysis was performed to generate items and factors for the PAPEMCS, and confirmatory factor analysis (CFA) was used to establish the construct validity. The generalizability of the PAPEMCS was evaluated by congruence tests and multigroup CFA. The usefulness of the PAPEMCS was established by the relationship between the PAPEMCS and non-urgent usage of pediatric emergency medical care services (PEMCS). Results: The PAPEMCS compromised 4 factors: “anxiety about quality of PEMCS”, “anxiety about PEMCS system”, “anxiety about public support”, and “anxiety about private support”. All reliability estimates (polychoric ordinal alpha coefficients, item-rest correlations), the item discrimination, 5 fit indices for CFA, the convergent validity (indicator reliabilities, composite reliabilities, average variance extracteds), and the discriminant validity fulfilled the acceptability thresholds. All generalizability estimates fulfilled the predetermined levels of acceptability (Tucker’s congruence coefficients, congruence tests, strict factorial invariance). The usefulness of the PAPEMCS was established by the higher scores of the PAPEMCS being related to non-urgent usage of PEMCS. Conclusions: The PAPEMCS demonstrated satisfactory reliability, validity, generalizability and usefulness. The PAPEMCS is useful to quantify the contents and extent of parental anxiety about PEMCS, and to clarify the mechanisms of non-urgent PEMCS usage.

Palliative Care in Emergency Medicine. What Are We Missing?

Patients present to the emergency department with critical and complex medical conditions that require a broad scope of medicine to achieve patient outcomes. Emergency medicine physicians are recognizing the importance and positive outcomes that arise when palliative care teams are consulted in the emergency room. Today, medical schools, residency programs, and emergency departments are requiring palliative care curriculum apart of their education. However, there continues to be a gap in early initiation of palliative care in emergency medicine. Nurse practitioners are becoming pivotal in the emergency department, and patients are considering them key providers in their medical journey. The role of an advanced practice nurse in an emergency room may be optimal for the early onset of palliative care consultation. This manuscript examines current knowledge that explores the background of palliative care, the current practice in the emergency department, the positive outcomes and gaps that still exist today, and the increasing role of an advanced practice nurse in the emergency room and their impact on palliative care initiation.

Emergency Obstetric Care in Parakou: Availability in Maternity Hospitals, Knowledge, Attitudes and Practices of Providers

Objective: To evaluate the availability of emergency obstetric care (EmOC) in maternity hospitals in Parakou as well as the knowledge, attitudes and practices of EmOC providers in 2017. Material and method: This was a descriptive, cross-sectional analytical study conducted in the maternity wards of public and private health facilities in Parakou and the health care providers of the maternity wards. Epi Data software version 3.1, Epi Info version 7.2 and EXCEL 2007 were used for data processing. Results: A total of 17 maternity homes and 91 providers participated in the study. All 7 basic functions (BEmOC) were available in 23.53% of these maternities. Providers’ knowledge of EmOC was good at 6.59%, average at 15.38%, insufficient at 24.18% and bad at 53.85%. As for the attitudes, they were just in 3.30%, approximate in 36.26%, wrong in 26.37% and harmful in 34.07%. Regarding the practices of these providers, they were adequate in 6.59%, inadequate in 38.46% and harmful in 54.95%. The global knowledge, attitudes and practices (CAP) score is acceptable in the majority of providers (57.14%). It is poor in 38.46% and good in 4.40%. Conclusion: In Parakou, the availability of emergency obstetric care (EmOC) contrasts with the level of knowledge, attitudes and practices of providers who require training in EmOC.

A systematic review of dedicated models of care for emergency urological patients

Objective:To systematically evaluate the spectrum of models providing dedicated resources for emergency urological patients(EUPs).Methods:A search of Cochrane,Embase,Medline and grey literature from January 1,2000 to March 26,2019 was performed using methods pre-published on PROSPERO.Reporting followed Preferred Reporting Items for Systematic Review and meta-analysis guidelines.Eligible studies were articles or abstracts published in English describing dedicated models of care for EUPs,which reported at least one secondary outcome.Studies were excluded if they examined pathways dedicated only to single presentations,such as torsion,or outpatient solutions,such as rapid access clinics.The primary outcome was the spectrum of models.Secondary outcomes were time-to-theatre,length of stay,complications and cost.Results:Seven studies were identified,totalling 487 patients.Six studies were conference abstracts,while one study was of full-text length but published in grey literature.Four distinct models were described.These included consultant urologists allocated solely to the care of EUPs(“Acute Urological Unit”)or dedicated registrars or operating theatres(“Hybrid structures”).In some services,EUPs bypassed emergency department assessment and were referred directly to urology(“Urological Assessment Unit”)or were managed by other dedicated means.Allocating services to EUPs was associated with reduced time-to-theatre,length of stay and hospital cost,and improved supervision of junior medical staff.Conclusion:Multiple dedicated models of care exist for EUPs.Low-level evidence suggests these may improve outcomes for patients,staff and hospitals.Higher quality studies are required to explore patient outcomes and minimum requirements to establish these models.

Knowledge and Practice in Emergency Obstetric and Neonatal Care (EmONC) Providers in Kinshasa, Democratic Republic of Congo

Context: Maternal and newborn mortality remains a public health concern worldwide. Although its ratio decreased by around 44% from 1990 to 2015, this rate remains high in developing regions, particularly in sub-Saharan Africa. Objectives: To evaluate the level of knowledge and practice of Emergency Obstetric and Neonatal Care (EmONC) of health providers in maternity hospitals in Kinshasa and to identify the causes of the non-practice of EmONC. Methods: A descriptive study was conducted from September 1, 2016 to January 31, 2017 in 21 medical facilities drawn from the 6 health districts of the city of Kinshasa. We analyzed data obtained by interviewing 675 healthcare providers from different professional categories working in gynecology departments and in delivery rooms. The 50% acceptability criterion was set to assess their knowledge and practice. Results: Among the providers, 385 of them (57%) had already heard of EmONC and most of them were general practitioners with a rate of 55.8% of all participants, but specialists were the ones who defined them well. Supervision by trained colleagues was the main source of information on EmONC with 32.5%, while structured training only concerned 24% of our providers and 43% of providers had no training in EmONC. The level of knowledge was deemed satisfactory with 56.4% for the whole population but below the average for general practitioners. 32.2% of our sample did not practice the EmONC and the lack of training was the main reason for this non-practice. Conclusion: EmONC as a strategy in the fight against maternal mortality is not known. Its functions are known within the framework of basic training and current practice. Structured training only concerned 24% of our service providers and 43% of them had no training in EmONC.

Level of Stress at Nurses Working in Emergency Clinic and Central Intensive Care: University Clinical Centre of Kosovo

Background: Emergency Clinic (EC) and Central Intensive Care (CIC) are high-stress environments that directly affect the health status of nurses. Methods: The aim of this study was to assess the level of stress at nurses working in the Emergency Clinic and nurses working in the Central Intensive Care. The study included 90 nurses, 45 nurses working in Emergency Clinic and 45 nurses working in Central Intensive Care. The study applied the Emergency Nurse Stress Questionnaire as an instrument to gather the data. This questionnaire was adopted from the Operational Police Stress Questionnaire in order to serve for the function and aim of the present study. Results: Nurses’ cohort-age ranged from 20 to 62 years. The largest proportion of respondents 40 (44.4%) was in the 20 - 30 age group, 58 (64.4%) were married, 60 (66.6%) hold bachelor degree and (33.3%) were with secondary school educational level. In terms of work-related fatigue, significant difference was found in working hours, participants reported that there was a significant difference in fatigue between 12 hours shift nurses (61 ± 10.5) compared to 8 hours nurses (41 ± 23.6) with P < 0.001. Results indicated that a vast majority of participants reported moderate to high levels of stress (81% of participants). There was no significant difference in the level of stress between the two groups of participants. There were also no significant differences compared to their demographic characteristics. Conclusion: These findings emphasize the role of using and assuring adequate strategies for ensuring quality management and finding ways of facilitating the increase in the number of nursing staff in these two departments because workplace overload and fatigue are potential factors that increase nurses’ stress levels.

Are Mentorship and Training the Key in Provision of Emergency Obstetric and New-Born Care (EmONC) Services? A Formative Evaluation of Pre and Post in Samburu County, Kenya

Background: In Kenya, the Maternal Mortality Ratio (MMR) is approximated to 362 maternal deaths per 100,000 live births while the stillbirth rate stands at 23 deaths per 100 live births which are far below the target of 147 maternal mortality per 100,000 live births and 12 stillbirths per 100 live births respectively. Progress in addressing preventable maternal and newborn deaths and stillbirths depend on the improvement of the quality of maternal, fetal and newborn care throughout the continuum of care. Objective: To determine the effect of mentorship and training in improving the provision of Basic Emergency Obstetric Newborn Care (BEmONC) and Comprehensive Emergency Obstetric Newborn Care (CeMONC) services among health workers in Samburu County. Methodology: A one-week training intervention was carried among health workers in level three, four and five health facilities by master trainers. Using two tools adopted from MEASURE Evaluation and a structured questionnaire, a total of 54 (before the intervention) and 64 (after the intervention) health workers from 29 health facilities were interviewed. Training effectiveness was assessed by means of questionnaires administered pre- and post-training, by correlating post-training results of health workers, and through participatory observations at the time of on-site supervisory visits, mentorship and monthly meetings. An assessment was conducted to measure the level of confidence of the health workers in performing their duties. Results: Central Samburu had the majority of the health workers both at the pre-intervention (44.4%) and post-intervention (51.6%), North Samburu had an extra health worker at post-test while no change in numbers was recorded in East Samburu. A majority of the health workers across the three sub-counties were 31 - 40 years old, with only 2 (3.8%) aged 51 years and above. Following the interventions, improvements in the practice of BEmONC services were seen across the three sub-counties. There was an increase, at post analysis, in the use of the partograph to monitor labour (from 52% to 98.1%) and managing severe infection in the newborn (from 40.4% to 60.3%). Performing CS improved from 17.3% to 31% and the same was also recorded in carrying out blood transfusions. On post-survey, health workers reported the least confidence in performing manual vacuum. Other BEmONC services including active management of 3rd stage labor, use of partograph, manual removal of the placenta, managing maternal sepsis and identifying danger signs in the newborn had a high rate of confidence. Conclusions: This study finds that structured mentorship is an effective strategy to build the capacity of health workers. However, there is a need for further research to monitor and evaluate if such programmes improve clinical outcomes in the long run.

Emergency department visits:Why adults choose the emergency room over a primary care physician visit during regular office hours?

BACKGROUND:It has been estimated that up to one third of all emergency department(ED)visits may be"inappropriate"or non-emergent.Factors that have been speculated to be associated with non-emergent use have been noted to include low socioeconomic status,lack of access to primary care,lack of insurance,convenience of"on demand care"and the patient's individual perception of their complaint urgency.The objective of this study is to identify the reasons contributing to self-perceived non-emergent adult emergency department visits during primary care physician office hours of operation.METHODS:This study was a single-center,descriptive study with questionnaire.The questionnaire was collected from patients meeting exclusion/inclusion criteria who were triaged into an acute or fast track part of the emergency department during regular business hours on Monday through Friday,8:00 am-5:00 pm during the months of July 2011 and August 2011.Questionnaire data were categorical and summarized using counts and percentages.Data collected included patient demographics,information about the patient's primary care provider,and information about the emergency department visit in question.All responses were compared among patients with visits considered to be non-emergent to those considered to be emergent by using individual chi-square tests.RESULTS:There were 262 patients available for the study.The patients were grouped according to their perception of the severity of their complaints.Roughly half of the patients placed themselves into the non-emergent category(n=129),whereas the other half of the patients categorized themselves into the emergent group(n=131).There were statistically significant differences in marital status and employment status between the two groups.It was found that 61.5%of the non-emergent patients were single,while 58.3%of the emergent patients were married.In the non-emergent group,59.7%were unemployed,but in the emergent group 60.3%were employed(P<0.05).However,no other factors were significantly different.CONCLUSIONS:Our study did not identify a statistically significant factor to the reasoning behind why patients choose the emergency department over a primary care physician during regular office hours.The only significant demographic indicating who was more likely to make this choice during the specified time frame was being single and employed with perceived non-emergent complaint.Patients without insurance and/or without a primary care physician were no more likely to visit the emergency department with a self-perceived non-emergent issue than patients with insurance and/or with an established primary care physician.