Assessing primary healthcare disaster preparedness: a study in Northern Italy

AIM

The aim of this paper is to outline the steps taken to develop an operational checklist to assess primary healthcare (PHC) all-hazards disaster preparedness. It then describes a study testing the applicability of the checklist.

BACKGROUND

A PHC approach is an essential foundation for health emergency and disaster risk management (H-EDRM) because it can prevent and mitigate risks prior to disasters and support an effective response and recovery, thereby contributing to communities' and countries' resilience across the continuum of the disaster cycle. This approach is in line with the H-EDRM framework, published by the World Health Organization (WHO) in 2019, which emphasizes a whole-of-health system approach in disaster management and highlights the importance of integrating PHC into countries' H-EDRM. Nevertheless, literature focusing on how to practically integrate PHC into disaster management, both at the facility and at the policy level, is in its infancy. As of yet, there is no standardized, validated way to assess the specific characteristics that render PHC prepared for disasters nor a method to evaluate its role in H-EDRM.

METHODS

The checklist was developed through an iterative process that leveraged academic literature and expert consultations at different stages of the elaboration process. It was then used to assess primary care facilities in a province in Italy.

FINDINGS

The checklist offers a practical instrument for assessing and enhancing PHC disaster preparedness and for improving planning, coordination, and funding allocation. The study identified three critical areas for improvement in the province's PHC disaster preparedness. First, primary care teams should be more interdisciplinary. Second, primary care services should be more thoroughly integrated into the broader health system. Third, there is a notable lack of awareness of H-EDRM principles among PHC professionals. In the future, the checklist can be elaborated into a weighted tool to be more broadly applicable.

Factors causing emergency medical care overload during heatwaves: A Delphi study

Heatwaves pose an important risk for population health and are associated with an increased demand for emergency care. To find factors causing such overload, an online Delphi study included 15 experts in emergency medicine, disaster medicine, or public health. One open-ended question was delivered in the first round. After content analysis, the obtained statements were sent to the experts in two rounds to be rated on a 7-point linear scale. Consensus was defined as a standard deviation ≤ 1.0. Thirty-one statements were obtained after content analysis. The experts agreed on 18 statements, mostly focusing on the input section of patient processing and identifying stakeholders, the population, and primary care as targets of potential interventions. Additional dedicated resources and bed capacity were deemed important as per throughput and output sections, respectively. These findings could be used in the future to implement and test solutions to increase emergency healthcare resilience during heatwaves and reduce disaster risk due to climatic change.

Sudden-Onset Disaster Mass-Casualty Incident Response: A Modified Delphi Study on Triage, Prehospital Life Support, and Processes

The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.

Management of Mass-Casualty Incidents in Nepal: A Qualitative Case Study of Three District Hospitals in Nepal

INTRODUCTION

The frequency of disasters world-wide has significantly increased in recent years, leading to an increase in the number of mass-casualty incidents (MCIs). These MCIs can overwhelm health care systems, requiring hospitals to respond quickly and effectively, often with limited resources. While numerous studies have identified the challenges in managing MCIs and have emphasized the importance of hospital disaster preparedness, there is a research gap in the preparedness level and response capacities of district hospitals in Nepal.

STUDY OBJECTIVE

This study attempts to fill this gap by understanding the perception of hospital staff in managing MCIs in district hospitals of Nepal.

METHODS

A qualitative case study was conducted in three district hospitals in Nepal. Semi-structured interviews were conducted with the hospital personnel, using an interview guide. An inductive thematic analysis was carried out to understand their perception on the most recent MCI management.

RESULTS

Three themes emerged from the data analysis: enablers in MCI management, barriers in MCI management, and recommendations for the future. Use of multiple communication channels, mobilization of entire hospital teams, mobilization of police in crowd control, presence of disaster store, and pre-identified triage areas were the major enablers that facilitated successful MCI management. Nonetheless, the study also revealed challenges such as a lack of knowledge on MCI response among new staff, disruptions caused by media and visitors, and challenges in implementing triage.

CONCLUSION

This study emphasized the importance of hospital disaster preparedness in managing MCIs and highlighted the significance of overcoming barriers and utilizing enablers for an efficient response. The findings of this study can provide the basis for the Ministry of Health and Population Nepal and district hospitals to plan initiatives for the effective management of MCIs in the future.

The Challenge of Mass Casualty Incident Response Simulation Exercise Design and Creation: A Modified Delphi Study

BACKGROUND

A Mass Casualty Incident response (MCI) full scale exercise (FSEx) assures MCI first responder (FR) competencies. Simulation and serious gaming platforms (Simulation) have been considered to achieve and maintain FR competencies. The translational science (TS) T0 question was asked: how can FRs achieve similar MCI competencies as a FSEx through the use of MCI simulation exercises?

METHODS

T1 stage (Scoping Review): PRISMA-ScR was conducted to develop statements for the T2 stage modified Delphi (mD) study. 1320 reference titles and abstracts were reviewed with 215 full articles progressing for full review leading to 97 undergoing data extraction.T2 stage (mD study): Selected experts were presented with 27 statements derived from T1 data with instruction to rank each statement on a 7-point linear numeric scale, where 1 = disagree and 7 = agree. Consensus amongst experts was defined as a standard deviation ≤ 1.0.

RESULTS

After 3 mD rounds, 19 statements attained consensus and 8 did not attain consensus.

CONCLUSIONS

MCI simulation exercises can be developed to achieve similar competencies as FSEx by incorporating the 19 statements that attained consensus through the TS stages of a scoping review (T1) and mD study (T2), and continuing to T3 implementation, and then T4 evaluation stages.

A Qualitative Study on the Use of the Hospital Safety Index and the Formulation of Recommendations for Future Adaptations

The Hospital Safety Index is a tool developed by the World Health Organization and the Pan American Health Organization in 2008 and updated in 2015. Although it is the most widely used instrument of its kind to assess the level of hospital preparedness, scientific literature on its application in real life is scarce. This study aimed to investigate the use of the Hospital Safety Index to assess disaster preparedness in healthcare facilities. A retrospective, qualitative study employing semi-structured online interviews was conducted to gather the opinions and perspectives of professionals who have experience in applying the Hospital Safety Index. Authors of scientific publications using the Hospital Safety Index were recruited. A semi-structured interview guide was developed. It addressed different phases of data collection with the Hospital Safety Index, the challenges and facilitators of using it, and recommendations for future adaptations. Data were analysed using inductive thematic analysis. Nine participants who were from three countries (Serbia, Sri Lanka, and Indonesia) and had different professional backgrounds (medical doctors, engineers, spatial planners, etc.) participated in this study. A total of 5 themes and 15 subthemes emerged during data analysis. Most of the participants reported their reasons for choosing the Hospital Safety Index as being its comprehensiveness and the fact that it was issued by the World Health Organization. The tool appears to be very specific and allows investigators to spot details in hospitals; however, it is not easy to use, and training is highly encouraged to learn how to navigate the different components of the tool. Governmental support is a crucial facilitator for investigators to be able to enter hospitals and conduct their evaluations. Overall, the tool has a lot of potential, and it should be used to reach a broader audience, such as community members, and assess the preparedness of other facilities that can take part in the response to disasters (hotels, stadiums, schools, etc.). Nevertheless, it still needs more adaptations to be tailored to different contexts and settings.

A Review of COVID-19 Response Challenges in Ethiopia

BACKGROUND

The COVID-19 pandemic has positioned fragile healthcare systems in low-income countries under pressure, leading to critical gaps in service delivery. The pandemic response demands the healthcare system to be resilient and continue provision of healthcare services. This review is aimed at describing the healthcare response challenges during the pandemic in Ethiopia.

METHODOLOGY

Eligible studies dealing with challenges of the healthcare system in response to the COVID-19 pandemic in Ethiopia were included. The six World Health Organization (WHO) healthcare system building blocks were used to categorize healthcare challenges. PubMed ProQuest, databases were searched, and results were summarized using systematic review synthesis.

RESULTS

Financial constraints led to a shortage of mechanical ventilators. Furthermore, the pandemic hindered the capacity to avail full packages of personal protective equipment in health facilities and intensive care capacity. The pandemic also affected the delivery of maternal, child and new-born services, prevention, and treatment of childhood illness, including immunization services.

CONCLUSIONS

The COVID-19 pandemic posed various challenges to the performance of the healthcare system in Ethiopia. It is recommended that policy makers and stakeholders enhance pandemic preparedness and strengthen response capacity by considering the six WHO healthcare system building blocks.

Evaluating the level of disaster preparedness of Tunisian University Hospitals using the Hospital Safety Index: a nationwide cross-sectional study

Background

Mid-way through the 'Sendai Framework for Disaster Risk Reduction 2015-2030', many nations are spending time, money and effort to enhance their level of preparedness facing disasters, on the other hand communities, countries and even continents are being left behind.

Objectives

This study was conducted aiming at evaluating the level of disaster preparedness and response of Tunisian University Hospitals.

Methods

This is a cross-sectional nationwide study conducted in Tunisia, from November 2020 to April 2021. Including 9 Tunisian University Hospitals and using the Hospital Safety Index. The data were analysed using the 'Module and safety index calculator'.

Results

This study showed that 7 out of the 9 University Hospitals were assigned the 'B' category of safety with overall safety indexes that ranges between 0.37 and 0.62. Also, 4 out of 9 University Hospitals had safety scores less than 0.20 regarding their emergency and disaster management.

Conclusions

This is the first study to evaluate disaster preparedness and response of university hospitals in Tunisia and in north Africa. It showed that the lack of knowledge, resources and willingness, are the most important issues that needs to be addressed in order to enhance the preparedness of Tunisian hospitals.

Disaster preparedness level of university hospitals of Sousse -Tunisia

Background

Disasters, whether natural or man-made, are unpredictable. The health care systems, represented by hospitals, are on the front lines of the emergency and disaster response. Tunisian health structures, must be able to cope with a case of mass influx of victims following any disasters. Therefore, we conducted this study to describe the level of disaster preparedness of University Hospitals of Sousse - Tunisia.

Methods

A simple descriptive quote is the basis of a data collection, conducted between September and October 2019 and performed in both University Hospitals of Sousse - Tunisia (Farhat Hached and Sahloul). The measuring instrument used in this study is the 'Hospital Safety Index' designed by the World Health Organization in 2008.

Data was analyzed using the 'Module and safety index calculator' which calculates a specific score for each module (structural safety, nonstructural safety and emergency and disaster management) and an overall score for hospital safety, and assigns an appropriate classification which can be “c/C” corresponds to a score from 0 to 0.35, “b/B” from 0.36 to 0.65, or “a/A” from 0.66 to 1.

Results

The overall safety index class of both hospitals was 'B'. Sahloul University Hospital was classified as 'a' in both structural and nonstructural safety modules and classified as 'c' in the emergency and disaster management module, in the other hand Farhat Hached University Hospital was classified as 'c' in structural safety module and classified as 'b' in both nonstructural safety and emergency and disaster management modules.

Conclusions

The hospitals' current levels of emergency and disaster management needs to be improved. Actually, both patients and staff safety as well as the hospital's ability to function during and after emergencies and disasters are potentially at risk. In both hospitals, intervention measures are needed in the short term.

Key messages

Appropriate disaster management should be based on a clear plan, preparedness and collaborative and effective efforts on the part of the community and the different organizations involved. A safe hospital needs to assure that its services remain accessible and functioning at maximum capacity, before, during and immediately after the impact of emergencies and disasters.

Burnout and its associated factors among Tunisian healthcare students

Background

Burnout is a major issue among healthcare students and a public health issue in general. Indeed, the consequences of student burnout are as complex such as mental distress factors with smoking and alcohol consumption and unhealthy lifestyle. The aim of this study is to determine the prevalence of burnout among health sciences students and its associated factors.

Methods

This is a cross sectional descriptive study conducted among 368 students of the Higher School of Health Sciences and Techniques of Sousse (Tunisia) from March to April 2018. The study instrument is the French validated version of the Maslach Burnout Inventory-Student Survey (MBI-SS). This instrument measures academic burnout through 3 dimensions (emotional exhaustion, cynicism and academic efficacy). Data entered and analyzed using the Statistical Package for the Social Sciences (SPSS 20.0).

Results

The prevalence of burnout was 64.4%. The presence of a diagnosed health problem, a diagnosed mental disorder or sleep problems found to be associated with all the aspects of burnout. Students who live alone are significantly the most emotionally exhausted (p = 0.010), and have the highest levels of cynicism (p = 0.033). Students who had a low socio-economic level are significantly more cynical than those who had a medium or high socio-economic level (m = 3.45, m = 2.81, m = 2.25; p = 0.032 respectively). Furthermore, students who perform leisure activities and practice physical activities had a significantly lower levels of emotional exhaustion (p = 0.007, p = 0.008 respectively). Also, studying with new pedagogical approaches decreased significantly the levels of the different burnout dimensions.

Conclusions

Burnout is prevalent among Tunisian health sciences students, which can have severe consequences such as anxiety and sleep disorders. Hence why preventive strategies should be applied to encounter this problem and avoid its consequent risks.

Key messages

Students and teachers must be aware of the phenomenon of burnout and its consequences as an important public health issue. Future interventions to minimize the prevalence of burnout and its negative effects should be conducted by focusing on its associated factors.

Assessment of patient safety culture in intensive care units and factors affecting it

Background

The intensive care units are a high-risk environments for the occurrence of adverse events with serious consequences. The development of patient safety culture is a strategic focus to prevent these adverse events and improve patient safety and healthcare quality. This study aimed to assess patient safety culture in Tunisian intensive care units and to determine its associated factors.

Methods

It is a multicenter, descriptive cross-sectional study, among healthcare professionals of the intensive care units in the Tunisian center. The data collection was spread over a period of 2 months (October-November 2017). The measuring instrument used is the validated French version of the Hospital Survey On Patient Safety Culture questionnaire. Data entry and analysis was carried out by the Statistical Package for Social Sciences (SPSS 20.0) and Epi Info 6.04. Chi-square test was used to explore factors associated with patient safety culture.

Results

A total of 404 professionals participated in the study with a participation rate of 81.94%, spread over 10 hospitals and 18 units. All dimensions were to be improved. The overall perception of safety was 32.35%. The most developed dimension was teamwork within units with a score of 47.87% and the least developed dimension was the non-punitive response to error (18.6%). The patient safety culture was significantly more developed in private hospitals in seven of the 10 dimensions. Participants working in small units had a significantly higher patient safety culture. It has been shown that when workload is reduced the patient safety culture was significantly increased.

Conclusions

This study has shown that the patient safety culture still needs to be improved and allowed a clearer view of the safety aspects requiring special attention. Thus, improving patient safety culture. by implementing the quality management and error reporting systems could contribute to enhance the quality of healthcare provided to patients.

Key messages

The culture of culpability is the main weakness in the study. Encouraging event reporting and learning from errors s should be priorities in hospitals to enhance patient safety and healthcare quality.

Evaluation of teamwork in operating rooms in a Tunisian university hospital

Background

Teamwork is fundamental to ensuring the quality of care and patient safety in operating rooms. It has been shown that the occurrence of adverse events is closely linked to a poor quality of teamwork in these settings. Thus, this study aimed to assess teamwork in different operating rooms of the university hospital of Sahloul Sousse (Tunisia).

Methods

It is a descriptive cross-sectional study with convenience sampling, conducted in operating rooms of the university hospital of Sahloul Sousse (Tunisia) between February and April 2018. The measuring instrument was the validated observation grid 'Communication and Teamwork Skills Assessment Tool (CATS) '. Teamwork is assessed through 4 domains (Situation awareness, Coordination, Communication, Cooperation). Behaviors are marked in rows each time they occur and are rated for quality in columns labeled “Observed and Good,” “Variation in Quality” (meaning incomplete or of variable quality), and “Expected but not Observed.”

Results

A total of 51 interventions were observed. Good coordination between the team members was noted, as well as good cooperation within the teams. A variation of quality level of communication with the patient was noted in 31.4% of cases, also communication about the context, the situation and recommendation among caregivers is not quite good with a percentage of 39.2%. Moreover, the work environment was rated as good in 84.3% of cases.

Conclusions

Some failures in teamwork were noted, hence it is important to take corrective measures for better practice and better patient management in such a complex environment, the operating rooms, where there is a strong need for team coordination.

Key messages

There is a direct relationship between the quality of care and the effectiveness of teamwork. It is necessary to eliminate the barriers to communication, in order to prevent adverse events.

Evidence-based practice competency and its related factors among healthcare students

Background

Evidence-based practice today is a worldwide approach in optimizing quality of healthcare. This approach remains little known among Tunisian future healthcare professionals. This study aimed to describe health sciences students' competencies in Evidence-based practice (attitudes, skills and knowledge) and to determine factors associated with these competencies.

Methods

A descriptive cross-sectional study was conducted from February to March 2018, at the Higher School of Health Sciences and Techniques of Sousse (Tunisia) among health sciences students. Data were collected using the validated Evidence Based Practice Competencies Questionnaire (EBP-COQ) measuring students' knowledge, attitudes and skills in Evidence-based practice. The Statistical Package for Social Sciences (SPSS.20) software was used to analyze data. Independent-Samples T test and One-way ANOVA test were performed to assess the differences between the different subgroups and their association with the Evidence-based practice components.

Results

Altogether, 365 students participated to the study (response rate: 93.11%). The overall Evidence Based Practice Competencies score was 3.26±0.53 out of 5. The attitude, skills and knowledge subscales received 4.04±0.41; 3.05±0.77 and 2.70±0.74 as mean scores respectively. Students' demographic and academic features were significantly associated with their competencies in Evidence-based practice including age (p < 10-6), gender (p < 10-3), academic degree (p < 10-6), English-language reading skills (p < 10-6), students' education in research methodology (p < 10-6) and statistics (p < 10-5), and their familiarity with the term “Evidence-based practice”(p < 10-6).

Conclusions

The reported knowledge and attitudes among the future caregivers is considered below the required competency standards. These findings highlight the urgent need for changes in the current educational strategies to ensure successful implementation of Evidence-based practice in Tunisia.

Key messages

The transition from studentship to a professional health-caring role requires that students are well equipped with EBP competencies to increase their likelihood of utilizing EBP in their future. Understanding the underlying factors that may influence Evidence based practice competencies is useful in developing teaching strategies for effective EBP.

Description of healthcare professionals’ attitudes on patient safety in the Tunisian operating rooms

Background

Currently, ensuring surgical safety remain a worldwide challenge. The description of operating room professionals' attitudes toward patient safety in their work units helps to identify strengths and weaknesses in term of patient safety, allowing a clearer vision of the safety aspects that require special attention. This study aimed to describe healthcare professionals' attitudes on patient safety in the Tunisian operating rooms.

Methods

This is a cross-sectional descriptive study spread over a 6-month period (October-April 2018). It was conducted among healthcare professionals working in the operating rooms of the two teaching hospitals of Sousse (Tunisia). The measuring instrument used is the Operating Room Management Attitudes Questionnaire (ORMAQ), which consists of 60 items spread over 8 dimensions. The latter has been subjected to a transcultural validation process inspired from the Vallerand method. Data entry and analysis was done by the Statistical Package for Social Sciences (SPSS.20) software.

Results

A total of 303 professionals participated in the study (participation rate= 76.13%). The most developed dimension was teamwork and the least developed was “Procedural errors/ compliance”. Items' results show that 94.8% of professionals confirmed that seniors should encourage medical and paramedical staff to ask questions, 53.5% of professionals stated that personal problems can adversely affect their performance and 87.5% agreed that operating rooms' team members share responsibilities for prioritizing activities in high workload situations. In addition, 50.9% of participants reported that the managers don't listen to staff or care about their concerns.

Conclusions

Operating rooms professionals' attitudes toward patient safety in their work units reflect an alarming situation regarding the quality of healthcare provided to patients. These results should be taken into consideration to guide future intervention on quality management improvement.

Key messages

Considering human factors is essential to improve safety in operating rooms and has an important role in reducing the occurrence of adverse events in these settings. It is important to study the underlying attitudes that determine the human factors for a better understanding and resolution of patient safety problems.

Surgical gloves' perforation rate and its associated factors in three Tunisian surgical departments

Background

Surgical teams rely on gloves as a barrier that can prevent transmission of microorganisms from the practitioners to the patient and from patient to surgical team. However, holes and micro-perforations may occur in gloving material exposing both patients and surgical team members to several complications. This study aimed to investigate the gloves' perforation rate and the factors associated with glove defect.

Methods

It is descriptive cross-sectional study. It was spread over a period of 3 months (January-March 2017) and was conducted at the University Hospital of Sahloul-Sousse (Tunisia) in three different surgical departments (urology, maxillofacial and general and digestive surgery). A data collection sheet was used by the researchers to collect data about the intervention and the surgical teams such the type and the duration of the intervention and the type of gloves used by the surgical teams. The post-surgery gloves were collected and tested to detect perforations using the water-leak test as described in the European Norm “NF EN 455-1”. For percentage comparison, the chi-square test was used with a significance threshold of 5%.

Results

A total of 284 gloves were collected from 36 procedures. Of these, 47 were found to be perforated with a perforation rate of 16.5%. All perforations were unnoticed by the surgical team members. The majority of perforated gloves (61.7%) were collected after urology procedures (p = 0.00005), 77% of perforated gloves were detected when the duration of the procedure exceeded 90 minutes (p = 0.001), and 96% of gloves were from brand A, which were the thicker gloves (p = 0.015)

Conclusions

This study highlighted an important problem neglected by the surgical teams, despite the risks that it can generate and its potentially severe consequences. In light of this study, we recommend systematic double-gloving and frequent changing of gloves to prevent the gloves' perforation and reduce its risks.

Key messages

Surgical teams must be aware of the importance of the problem of gloves perforation. The findings reaffirm the importance of double-gloving and changing gloves in surgeries of more than 90 minutes duration.

Evaluation of teamwork and its associated factors in the emergency rooms of Sousse - Tunisia

Background

In recent years, patient safety has become a priority and a major target for improvement especially in the emergency rooms. According to the French National Authority for Health, 1/3 of serious adverse events could be avoided thanks to better coordination and better communication between the teams. Thus, this study aimed to describe the perceptions of healthcare professionals in the emergency rooms of Sousse-Tunisia regarding teamwork, and to determine the factors influencing it.

Methods

It is a descriptive cross-sectional study, conducted between December 2018 and April 2019. It included all the caregivers working in all the emergency rooms of Sousse-Tunisia. The measurement tool used in this study was “Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS)” Teamwork Perception Questionnaire. Data were coded and analyzed by The Statistical Package for Social Sciences (SPSS 20.0).

Results

A total of 110 participants were recruited with a participation rate of 72.36%. Nurses represent more than half of the respondents (56.4%). Average work experience was 7.27 years. The Teamwork overall score was 2.5±0.5. The most developed dimension was leadership (2.7±0.8) and the less developed dimension was communication (2.3±0.7). Women had a significantly higher overall score than men (2.6±0.5, 2.4±0.3, p = 0.017). Results also showed that emergency technicians have significantly higher overall score than doctors and nurses (p = 1 × 10-5). The overall score also varied significantly across the hospitals (p = 0.016).

Conclusions

Our results showed that the level of teamwork still needs to be improved. Furthermore, various factors are associated with teamwork, and that should be taken into consideration to guide the future interventions.

Key messages

There is a direct relationship between the quality of care and the effectiveness of teamwork. It is necessary to focus on the affecting factors of teamwork, in order to prevent adverse events.

[Diagnostic and surgical strategy for parathyroid adenoma]

From a retrospective study carrying on 8 patients operated for sporadic parathyroid adenoma, we underline the place of medical imagery which allowed the detection of parathyroid adenoma in 7 cases. For all our patients the exploration of thyroid space was bilateral, seeking parathyroid glands. The authors discuss the stages and the various processes of the surgical strategy for parathyroid glands' exploration.

[Ear myiasis. Two case reports]

The authors report two cases of aural myiasis. This pathology rarity induced us to search after epidemiologic, clinic and therapeutic peculiarity of this parasitical disease.