Management and Outcomes of Acute Surgical Patients at a District Hospital in Uganda with Non‐physician Emergency Clinicians

Dresser, Caleb; Periyanayagam, Usha; Dreifuss, Brad; Wangoda, Robert; Luyimbaazi, Julius; Bisanzo, Mark

doi:10.1007/s00268-017-4014-7

Cited by 12 publications

(9 citation statements)

References 42 publications

(44 reference statements)

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“…[31][32][33] Several studies have shown that training nonphysician providers in emergency care services is both feasible and associated with improved outcomes in resource-limited settings. [32][33][34][35][36][37][38] At the present time, The Gambia does not have a prehospital Emergency Medical Service (EMS) and there are no trained physicians or mid-level providers in emergency medicine, even though it has been reported that more than one-half of all deaths and around one-third of all disability-adjusted life years in LMICs like The Gambia could be addressed through prehospital and facility-based EMS. 39 The transport time to a health facility was under one hour for most respondents.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care

Touray

Sanyang

Zandrow

et al. 2018

Prehosp. Disaster med.

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BackgroundThe Gambia is going through a rapid epidemiologic transition with a dual disease burden of infections and non-communicable diseases occurring at the same time. Acute, time-sensitive, medical emergencies such as trauma, obstetric emergencies, respiratory failure, and stroke are leading causes of morbidity and mortality among adults in the country.ProblemData on medical emergency care and outcomes are lacking in The Gambia. Data on self-reported medical emergencies among adults in a selection of Gambian communities are presented in this report.MethodsA total of 320 individuals were surveyed from 34 communities in the greater Banjul area of The Gambia using a survey instrument estimating the incidence of acute medical emergencies in an adult population. Self-reported travel time to a health facility during medical emergencies and patterns of health-seeking behavior with regard to type of facility visited and barriers to accessing emergency care, including cost and medical insurance coverage, are presented in this report.ResultsOf the 320 individuals surveyed, 262 agreed to participate resulting in a response rate of 82%. Fifty-two percent of respondents reported an acute medical emergency in the preceding year that required urgent evaluation at a health facility. The most common facility visited during such emergencies was a health center. Eighty-seven percent of respondents reported a travel time of less than one hour during medical emergencies. Out-of-pocket cost of medications accounted for the highest expenditure during emergencies. There was a low awareness and willingness to subscribe to health insurance among individuals surveyed.Conclusion: There is a high incidence of acute medical emergencies among adults in The Gambia which are associated with adverse outcomes due to a combination of poor health literacy, high out-of-pocket expenditures on medications, and poor access to timely prehospital emergency care. There is an urgent need to develop prehospital acute care and Emergency Medical Services (EMS) in the primary health sector as part of a strategy to reduce mortality and morbidity in the country.TourayS, SanyangB, ZandrowG, TourayI. Incidence and outcomes after out-of-hospital medical emergencies in Gambia: a case for the integration of prehospital care and Emergency Medical Services in primary health care. Prehosp Disaster Med. 2018;33(6):650–657.

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Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care

Touray

Sanyang

Zandrow

et al. 2018

Prehosp. Disaster med.

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“…The unit covers the ED, but does not provide critical care or trauma care. No comprehensive ACS model was in place in Rwanda and Uganda [69,70].…”

Section: Africamentioning

confidence: 99%

Acute Care Surgery Models Worldwide: A Systematic Review

2020

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Background The Acute Care Surgery (ACS) model was developed as a dedicated service for the provision of 24/7 nontrauma emergency surgical care. This systematic review investigated which components are essential in an ACS model and the state of implementation of ACS models worldwide. Methods A literature search was conducted using PubMed, MEDLINE, EMBASE, Cochrane library, and Web of Science databases. All relevant data of ACS models were extracted from included articles. Results The search identified 62 articles describing ACS models in 13 countries. The majority consist of a dedicated nontrauma emergency surgical service, with daytime on-site attending coverage (cleared from elective duties), and 24/7 in-house resident coverage. Emergency department coverage and operating room access varied widely. Critical care is fully embedded in the original US model as part of the acute care chain (ACC), but is still a separate unit in most other countries. While in most European countries, ACS is not a recognized specialty yet, there is a tendency toward more structured acute care. Conclusions Large national and international heterogeneity exists in the structure and components of the ACS model. Critical care is still a separate component in most systems, although it is an essential part of the ACC to provide the best pre-, intra-and postoperative care of the physiologically deranged patient. Universal acceptance of one global ACS model seems challenging; however, a global consensus on essential components would benefit any healthcare system.

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“…The important study by Wilhelm et al. adds to others 1 that this is not the case. Nonetheless, the notion may die hard.…”

mentioning

confidence: 93%

Trauma care in the districts

Cotton

2017

Trop Doct

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Management and Outcomes of Acute Surgical Patients at a District Hospital in Uganda with Non‐physician Emergency Clinicians

Cited by 12 publications

References 42 publications

Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care

Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care

Acute Care Surgery Models Worldwide: A Systematic Review

Trauma care in the districts

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