Effect of a Brief Outreach Educational Intervention on the Translation of Acute Poisoning Treatment Guidelines to Practice in Rural Sri Lankan Hospitals: A Cluster Randomized Controlled Trial

Abstract

BackgroundIn developing countries, including Sri Lanka, a high proportion of acute poisoning and other medical emergencies are initially treated in rural peripheral hospitals. Patients are then usually transferred to referral hospitals for further treatment. Guidelines are often used to promote better patient care in these emergencies. We conducted a cluster randomized controlled trial (ISRCTN73983810) which aimed to assess the effect of a brief educational outreach (‘academic detailing’) intervention to promote the utilization of treatment guidelines for acute poisoning.Methods and FindingsThis cluster RCT was conducted in the North Central Province of Sri Lanka. All peripheral hospitals in the province were randomized to either intervention or control. All hospitals received a copy of the guidelines. The intervention hospitals received a brief out-reach academic detailing workshop which explained poisoning treatment guidelines and guideline promotional items designed to be used in daily care. Data were collected on all patients admitted due to poisoning for 12 months post-intervention in all study hospitals. Information collected included type of poison exposure, initial investigations, treatments and hospital outcome. Patients transferred from peripheral hospitals to referral hospitals had their clinical outcomes recorded. There were 23 intervention and 23 control hospitals. There were no significant differences in the patient characteristics, such as age, gender and the poisons ingested. The intervention hospitals showed a significant improvement in administration of activated charcoal [OR 2.95 (95% CI 1.28–6.80)]. There was no difference between hospitals in use of other decontamination methods.ConclusionThis study shows that an educational intervention consisting of brief out-reach academic detailing was effective in changing treatment behavior in rural Sri Lankan hospitals. The intervention was only effective for treatments with direct clinician involvement, such as administering activated charcoal. It was not successful for treatments usually administered by non-professional staff such as forced emesis for poisoning.Trial RegistrationControlled-Trials.com ISRCTN73983810 ISRCTN73983810

Treatment of self‐poisoning at a tertiary‐level hospital in Bangladesh: cost to patients and government

“…Although there would be a cost of care for managing these patients at peripheral hospitals, the expense is likely to be significantly less. Lessons from Sri Lanka suggest that increased support to peripheral hospitals can alter their patterns of poisoned patient transfers .…”

Global Emergency Medicine: A Review of the Literature From 2013

“…The top 24 global EM articles for 2013 are listed in Table . The complete database of all 434 global EM articles for 2013, as well as full summaries and critical analyses of the top 24 global EM of articles of 2013, can be found in Data Supplements S1 and S2 (available as supporting information in the online version of this article).…”

“…Most of the evidence supporting the WHO recommendations has been derived from tertiary hospital data, and this study supports a reevaluation of the current antibiotic recommendations for community‐dwelling patients. Finally, a study from Sri Lanka demonstrated that a brief educational workshop increased adherence to emergency treatment guidelines for acute poisonings, when compared to distributing printed guidelines alone …”

Emergency Medicine Training Programs in Low- and Middle-Income Countries: A Systematic Review

“…Finally, in order to continue to advance EM training and the overall provision of emergency care, programs must include training in quality improvement (QI) and research, topics not traditionally taught in many medical and nursing schools in low-resource settings. To illustrate this point, less than half of the programs mention a component of QI and/or research, and only two of the manuscripts have a local first author [31,44]. Furthermore, in order to determine which methods of training are most effective, we must move beyond metrics regarding knowledge acquisition and attitude and eventually look to patient-, community-, and population-based outcomes [55].…”

“…Fifteen of the high-scoring manuscripts focus on seven specific content areas (ultrasound, trauma, pediatrics, pediatric trauma, neurological emergencies, toxicological emergencies). They span the years 2012-2018, are pub- lished in twelve journals, and highlight work in thirteen countries ( Table 2) [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. Eleven of the manuscripts discuss general EM programs.…”