Acute care needs in a rural Sub-Saharan African Emergency Centre: A retrospective analysis

摘要

Introduction In June of 2008, Karoli Lwanga (“Nyakibale”) Hospital and Global Emergency Care Collaborative (GECC) opened the first functional Emergency Centre (EC) in rural Uganda. GECC is developing a training programme for a new cadre of midlevel Emergency Care Practitioners (ECPs), to increase access to quality emergency care. In order to determine the skills and resources needed, the unique practice demographics and the feasibility of treating patients in this setting must be understood. Methods A descriptive cross-sectional analysis of the first 500 consecutive patient visits in the EC’s patient care log was reviewed. Data on demographics, procedures performed, laboratory testing, bedside ultrasounds (USs) performed, radiographs (XRs) ordered, diagnoses, condition upon discharge and disposition were collated. Descriptive statistics were performed. Results Of the first 500 patient visits, there were 275 (55%) male visits and 132 (26.4%) visits for children under five. Procedures were performed in 367 (73.4%) patients. Laboratory testing, XRs and USs were performed in 188 (37.6%), 99 (19.8%) and 45 (7%) patients, respectively. Infectious diseases were diagnosed in 217 (43.4%) patients; traumatic injuries in 140 (28%) patients. Only one patient expired in the ED, and 401 (80.2%) were in good condition after treatment. One person was transferred to another hospital. After treatment, 180 (36%) patients were discharged home. Only five (1.0%) patients went directly to the operating theatre. Conclusions This pilot study describes the patient population, resource and training needs of a rural Emergency Centre in SSA. It demonstrates that acute care providers will be required to evaluate a wide variety of patient complaints, effectively utilise laboratory and radiologic testing, and perform numerous focused treatments and therapies. Specialised training programmes, such as GECC’s ECP programme, are needed to create providers able to provide high quality, lifesaving care.