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Towns K, Dolo I, Pickering AE, Ludmer N, Karanja V, Marsh RH, Horace M, Dweh D, Dalieh T, Myers S, Bukhman A, Gashi J, Sonenthal P, Ulysse P, Cook R, Rouhani SA. Evaluation of emergency care education and triage implementation: an observational study at a hospital in rural Liberia. BMJ Open 2023; 13:e067343. [PMID: 37202137 DOI: 10.1136/bmjopen-2022-067343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION In Liberia, emergency care is still in its early development. In 2019, two emergency care and triage education sessions were done at J. J. Dossen Hospital in Southeastern Liberia. The observational study objectives evaluated key process outcomes before and after the educational interventions. METHODS Emergency department paper records from 1 February 2019 to 31 December 2019 were retrospectively reviewed. Simple descriptive statistics were used to describe patient demographics and χ2 analyses were used to test for significance. ORs were calculated for key predetermined process measures. RESULTS There were 8222 patient visits recorded that were included in our analysis. Patients in the post-intervention 1 group had higher odds of having a documented full set of vital signs compared with the baseline group (16% vs 3.5%, OR: 5.4 (95% CI: 4.3 to 6.7)). After triage implementation, patients who were triaged were 16 times more likely to have a full set of vitals compared with those who were not triaged. Similarly, compared with the baseline group, patients in the post-intervention 1 group had higher odds of having a glucose documented if they presented with altered mental status or a neurologic complaint (37% vs 30%, OR: 1.7 (95% CI: 1.3 to 2.2)), documented antibiotic administration if they had a presumed bacterial infection (87% vs 35%, OR: 12.8 (95% CI: 8.8 to 17.1)), documented malaria test if presenting with fever (76% vs 61%, OR: 2.05 (95% CI: 1.37 to 3.08)) or documented repeat set of vitals if presenting with shock (25% vs 6.6%, OR: 8.85 (95% CI: 1.67 to 14.06)). There was no significant difference in the above process outcomes between the education interventions. CONCLUSION This study showed improvement in most process measures between the baseline and post-intervention 1 groups, benefits that persisted post-intervention 2, thus supporting the importance of short-course education interventions to durably improve facility-based care.
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Affiliation(s)
- Kathleen Towns
- Division of Hospital Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Isaac Dolo
- Partners In Health Liberia, Harper, Liberia
| | - Ashley E Pickering
- Emergency Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Nicholas Ludmer
- Partners In Health, Boston, Massachusetts, USA
- Department of Emergency Medicine, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Regan H Marsh
- Partners In Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Denny Dweh
- Partners In Health Liberia, Harper, Liberia
| | | | | | - Alice Bukhman
- Partners In Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jason Gashi
- Boston University, Boston, Massachusetts, USA
| | - Paul Sonenthal
- Partners In Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Patrick Ulysse
- Partners In Health, Boston, Massachusetts, USA
- Partners In Health Liberia, Harper, Liberia
| | - Rebecca Cook
- Partners In Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Shada A Rouhani
- Partners In Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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