Evaluation of emergency care education and triage implementation: an observational study at a hospital in rural Liberia.

Journal: BMJ open

Volume: 13

Issue: 5

Year of Publication: 2023

Affiliated Institutions:  Division of Hospital Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA katrobin@med.umich.edu. Partners In Health Liberia, Harper, Liberia. Emergency Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA. Partners In Health, Boston, Massachusetts, USA. McGill University, Montreal, Québec, Canada. Boston University, Boston, Massachusetts, USA.

Abstract summary 

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.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 χ analyses were used to test for significance. ORs were calculated for key predetermined process measures.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.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.

Authors & Co-authors:  Towns Dolo Pickering Ludmer Karanja Marsh Horace Dweh Dalieh Myers Bukhman Gashi Sonenthal Ulysse Cook Rouhani

Study Outcome 

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Statistics
Citations :  Jamison DT, Gelband H, Horton S, et al. . Disease control priorities, third edition (volume 9): improving health and reducing poverty. 2017. 10.1596/978-1-4648-0527-1
Authors :  16
Identifiers
Doi : e067343
SSN : 2044-6055
Study Population
Male,Female
Mesh Terms
Humans
Other Terms
accident & emergency medicine;education & training (see medical education & training);medical education & training
Study Design
Study Approach
Country of Study
Liberia
Publication Country
England