An observational study of adults seeking emergency care in Cambodia

Abstract

ObjectiveTo describe the characteristics and chief complaints of adults seeking emergency care at two Cambodian provincial referral hospitals.MethodsAdults aged 18 years or older who presented without an appointment at two public referral hospitals were enrolled in an observational study. Clinical and demographic data were collected and factors associated with hospital admission were identified. Patients were followed up 48 hours and 14 days after presentation.FindingsIn total, 1295 hospital presentations were documented. We were able to follow up 85% (1098) of patients at 48 hours and 77% (993) at 14 days. The patients’ mean age was 42 years and 64% (823) were females. Most arrived by motorbike (722) or taxi or tuk-tuk (312). Most common chief complaints were abdominal pain (36%; 468), respiratory problems (15%; 196) and headache (13%; 174). Of the 1050 patients with recorded vital signs, 280 had abnormal values, excluding temperature, on arrival. Performed diagnostic tests were recorded for 539 patients: 1.2% (15) of patients had electrocardiography and 14% (175) had diagnostic imaging. Subsequently, 783 (60%) patients were admitted and 166 of these underwent surgery. Significant predictors of admission included symptom onset within 3 days before presentation, abnormal vital signs and fever. By 14-day follow-up, 3.9% (39/993) of patients had died and 19% (192/993) remained functionally impaired.ConclusionIn emergency admissions in two public hospitals in Cambodia, there is high admission-to-death ratio and limited application of diagnostic techniques. We identified ways to improve procedures, including better documentation of vital signs and increased use of diagnostic techniques.

Implementing an Innovative Prehospital Care Provider Training Course in Nine Cambodian Provinces

“…Fourth, the course content was tailored to the most likely scenarios the providers would face, based on existing data on patterns of emergency presentations and referrals [ 16 ]. With obstetric and peripartum conditions comprising a large portion of hospital presentations in Cambodia, maternal and pediatric emergencies were given more attention in this curriculum than in most prehospital care provider training curriculums from more developed EMS systems.…”

“…Ambulances are mostly controlled by and stationed at the government referral hospitals with limited coordination occurring between facilities. Consequently, patients with emergency conditions most commonly arrive at health facilities via private vehicle, motorbike, taxi, or tuk-tuk (a passenger carrying cart pulled by a motorcycle) [ 16 ]. Research on interfacility transfer (IFT) for emergency obstetric and neonatal care (EmONC) has shown that nearly half of patients being referred are required to arrange their own transportation.…”

“…First, the training curriculum’s focus was based on the most common emergency conditions encountered by Cambodian providers. Data from prior studies on patterns of emergency patient presentations [ 16 ] and the MOH's Health Information System [ 18 ] were used to identify 38 high-yield emergency care learning topics. Please see Table 1 for a description of the included topics.…”

Strengthening the emergency referral system in Cambodia for women and children under five: a description of interventions and impact analysis

“…At the same time, few if any Cambodian hospitals have systems in place to assist in identifying and prioritizing ill patients as they arrive. 10 At many facilities, patients self-triage to the hospital department they deem most appropriate (eg, emergency department, intensive care unit, inpatient wards), where they are cared for in the order of arrival, delaying the care of critically ill patients and leading to worsened outcomes. With this in mind, as part of the project's efforts, a simple Cambodiaspecific triage system was designed and implemented at 35 referral hospitals.…”

“…Going further, unfortunately, many Cambodian healthcare providers lack adequate emergency-specific skills and training, and as a result often fail to utilize the tools required to recognize and manage complex obstetric, pediatric, and general emergencies. 10 Due to the limited supply of specialists and facilities with the capacity to care for life-threatening conditions, emergent patient referrals are often imperative. However, the Cambodian emergency referral system is difficult to navigate and inconsistently available.…”