Improving emergency and admission care in low-resource, high mortality hospital settings—not as easy as A, B and C

English, Mike

doi:10.1093/heapol/czab128

Cited by 5 publications

(9 citation statements)

References 16 publications

(20 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…The process includes clinical expertise, training programmes, human resource management, logistical and biomedical engineering support, and functioning supply chains. [36 , 40 , 41]…”

Section: Discussionmentioning

confidence: 99%

“…In this context, further research is required to find sustainable solutions for the implementation of training programmes in essential paediatric emergency and critical care in Madagascar. [36 , 44 , 45] This process must take into account the different levels of care available at various levels of referral pathways. [35] In addition to ETAT+ training programmes, it may be beneficial to develop a further training module covering more advanced levels of paediatric critical care (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…This strategy should include efforts to clarify the role of ETAT+ trainers within the human resource systems of health facilities to effectively contribute to quality improvement in essential paediatric emergency and critical care. [35,36] Participants identified further challenges in implementing ETAT+. Firstly, patient circuits need to be optimised in health facilities to improve triage and access to immediate emergency care.…”

Section: Articlementioning

confidence: 99%

“…The process includes clinical expertise, training programmes, human resource management, logistical and biomedical engineering support, and functioning supply chains. [36,40,41] Before the training, different stakeholders conducted a preparation workshop to define content and training methods of the ETAT+ pilot training. WHO management guidelines for hospital care of children provided the core elements of the ETAT+ training.…”

Section: Articlementioning

confidence: 99%

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A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar

Galatsch

Lang

Noa

et al. 2022

South Afr J Crit Care

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Background. Madagascar needs major efforts to achieve the UN Sustainable Development Goals, despite the considerable reduction of child mortality during past years. In this context, implementation of emergency triage assessment and treatment (ETAT) plays an important role. In recent years, ETAT training activities rarely took place in Madagascar. To strengthen ETAT in Madagascar, a pilot training course was conducted in December 2019 at the University Hospital Mahajanga. Objective. This study aims to evaluate if the ETAT+ pilot training content matches clinical needs in Madagascar and whether participants achieved their learning objectives.Methods. In this cross-sectional mixed-methods study, a 41-item questionnaire was used at the end of the ETAT+ training to evaluate their learning experience from the 12 participants (paediatricians, physicians, nurses and midwives). Six weeks after the training, guided interviews were conducted among five participants to describe how training content could be transferred into clinical practice in five health facilities. Results. Results suggest that this pilot project designed to contribute to the re-establishment of ETAT in Madagascar meets participants’ needs and is adapted to clinical realities in terms of transmitted knowledge, skills and competencies. However, results also show that considerable multi- disciplinary efforts are needed to advance ETAT+ implementation in Madagascar.Conclusions. Implementation processes of ETAT training programmes need re-evaluation to assure their validity to contribute to quality of care improvements efficiently. Further operational research is required to evaluate sustainable, innovative implementation strategies adapted to contexts in Madagascar.

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Section: Discussionmentioning

confidence: 99%

“…The process includes clinical expertise, training programmes, human resource management, logistical and biomedical engineering support, and functioning supply chains. [36 , 40 , 41]…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Articlementioning

confidence: 99%

Section: Articlementioning

confidence: 99%

See 3 more Smart Citations

A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar

Galatsch

Lang

Noa

et al. 2022

South Afr J Crit Care

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Pediatric Emergency Care in Low-Resource Settings

Olatunji,

Kokori,

Aderinto

et al. 2024

Curr Emerg Hosp Med Rep

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Cost Effectiveness of Strategies for Caring for Critically Ill Patients with COVID-19 in Tanzania

Shah¹,

Baker

Schell

et al. 2023

PharmacoEconomics Open

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Background The resources for critical care are limited in many settings, exacerbating the significant morbidity and mortality associated with critical illness. Budget constraints can lead to choices between investing in advanced critical care (e.g. mechanical ventilators in intensive care units) or more basic critical care such as Essential Emergency and Critical Care (EECC; e.g. vital signs monitoring, oxygen therapy, and intravenous fluids). Methods We investigated the cost effectiveness of providing EECC and advanced critical care in Tanzania in comparison with providing ‘no critical care’ or ‘district hospital-level critical care’ using coronavirus disease 2019 (COVID-19) as a tracer condition. We developed an open-source Markov model ( https://github.com/EECCnetwork/POETIC_CEA ) to estimate costs and disability-adjusted life-years (DALYs) averted, using a provider perspective, a 28-day time horizon, patient outcomes obtained from an elicitation method involving a seven-member expert group, a normative costing study, and published literature. We performed a univariate and probabilistic sensitivity analysis to assess the robustness of our results., Results EECC is cost effective 94% and 99% of the time when compared with no critical care (incremental cost-effectiveness ratio [ICER] $37 [−$9 to $790] per DALY averted) and district hospital-level critical care (ICER $14 [−$200 to $263] per DALY averted), respectively, relative to the lowest identified estimate of the willingness-to-pay threshold for Tanzania ($101 per DALY averted). Advanced critical care is cost effective 27% and 40% of the time, when compared with the no critical care or district hospital-level critical care scenarios, respectively. Conclusion For settings where there is limited or no critical care delivery, implementation of EECC could be a highly cost-effective investment. It could reduce mortality and morbidity for critically ill COVID-19 patients, and its cost effectiveness falls within the range considered ‘highly cost effective’. Further research is needed to explore the potential of EECC to generate even greater benefits and value for money when patients with diagnoses other than COVID-19 are accounted for. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-023-00418-x.

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Improving emergency and admission care in low-resource, high mortality hospital settings—not as easy as A, B and C

Cited by 5 publications

References 16 publications

A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar

A mixed-methods study on evaluating an updated, francophone version of ETAT+ training in Madagascar

Pediatric Emergency Care in Low-Resource Settings

Cost Effectiveness of Strategies for Caring for Critically Ill Patients with COVID-19 in Tanzania

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