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Article ; Online: Characteristics and impact of bedside procedure services in the United States: A systematic review.

Nandan, Anirudh / Wang, David / Bosinski, Cameron / Tahir, Peggy / Wang, Sally / Sonenthal, Paul D / Shafiq, Majid

2022 Volume 17, Issue 8, Page(s) 644–652

Abstract: Background: Bedside procedure services are increasingly employed within internal medicine departments to meet clinical needs and improve trainee education. Published literature on these largely comprises single-center studies; an updated systematic ... ...

Abstract	Background: Bedside procedure services are increasingly employed within internal medicine departments to meet clinical needs and improve trainee education. Published literature on these largely comprises single-center studies; an updated systematic review is needed to synthesize available data. Purpose: This review examined published literature on the structure and function of bedside procedure services and their impact on clinical and educational outcomes (PROSPERO ID: 192466). Data sources: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, multiple databases were searched for publications from 2000 to 2021. Study selection, data extraction, and data synthesis: Thirteen single-center studies were identified, including 12 observational studies and 1 randomized trial. Data were synthesized in tabular and narrative format. Services were typically staffed by hospitalists or pulmonologists. At a minimum, each offered paracentesis, thoracentesis, and lumbar puncture. While there was considerable heterogeneity in service structures, these broadly fit either Model A (service performing the procedure) or Model B (service supervising the primary team). Procedure services led to increases in procedure volumes and self-efficacy among medical residents. Assessment of clinical outcomes was limited by heterogeneous definitions of complication rates and by sparse head-to-head data involving suitable comparators. Published data pointed to high success rates, low complication rates, and high patient satisfaction, with a recent study also demonstrating a decreased length of stay. Conclusions: There are relatively few published studies describing the characteristics of bedside procedure services and their impact on clinical and educational outcomes. Limited data point to considerable heterogeneity in service design, a positive impact on medical trainees, and a positive impact on patient-related outcomes.
MeSH term(s)	Hospitalists ; Humans ; Internal Medicine ; Paracentesis ; Spinal Puncture ; Thoracentesis ; United States
Language	English
Publishing date	2022-06-06
Publishing country	United States
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2233783-0
ISSN	1553-5606 ; 1553-5592
ISSN (online)	1553-5606
ISSN	1553-5592
DOI	10.1002/jhm.12848
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Article ; Online: Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study.

Connolly, Emilia / Kasomekera, Noel / Sonenthal, Paul D / Nyirenda, Mulinda / Marsh, Regan H / Wroe, Emily B / Scott, Kirstin W / Bukhman, Alice / Minyaliwa, Tadala / Katete, Martha / Banda, Grace / Mukherjee, Joia / Rouhani, Shada A

BMC health services research

2023 Volume 23, Issue 1, Page(s) 1062

Abstract: Introduction: As low-income countries (LICs) shoulder a disproportionate share of the world's burden of critical illnesses, they must continue to build critical care capacity outside conventional intensive care units (ICUs) to address mortality and ... ...

Abstract	Introduction: As low-income countries (LICs) shoulder a disproportionate share of the world's burden of critical illnesses, they must continue to build critical care capacity outside conventional intensive care units (ICUs) to address mortality and morbidity, including on general medical wards. A lack of data on the ability to treat critical illness, especially in non-ICU settings in LICs, hinders efforts to improve outcomes. Methods: This was a secondary analysis of the cross-sectional Malawi Emergency and Critical Care (MECC) survey, administered from January to February 2020, to a random sample of nine public sector district hospitals and all four central hospitals in Malawi. This analysis describes inputs, systems, and barriers to care in district hospitals compared to central hospital medical wards, including if any medical wards fit the World Federation of Intensive and Critical Care Medicine (WFSICCM) definition of a level 1 ICU. We grouped items into essential care bundles for service readiness compared using Fisher's exact test. Results: From the 13 hospitals, we analysed data from 39 medical ward staff members through staffing, infrastructure, equipment, and systems domains. No medical wards met the WFSICCM definition of level 1 ICU. The most common barriers in district hospital medical wards compared to central hospital wards were stock-outs (29%, Cl: 21% to 44% vs 6%, Cl: 0% to 13%) and personnel shortages (40%, Cl: 24% to 67% vs 29%, Cl: 16% to 52%) but central hospital wards reported a higher proportion of training barriers (68%, Cl: 52% to 73% vs 45%, Cl: 29% to 60%). No differences were statistically significant. Conclusion: Despite current gaps in resources to consistently care for critically ill patients in medical wards, this study shows that with modest inputs, the provision of simple life-saving critical care is within reach. Required inputs for care provision can be informed from this study.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Malawi ; Patient Care Bundles ; Critical Care ; Hospitals ; Intensive Care Units ; Critical Illness
Language	English
Publishing date	2023-10-05
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-023-10014-8
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Article ; Online: Critical Care Units in Malawi: A Cross-Sectional Study.

Sonenthal, Paul D / Kasomekera, Noel / Connolly, Emilia / Wroe, Emily B / Katete, Martha / Minyaliwa, Tadala / Marsh, Regan H / Banda-Katha, Grace / Nyirenda, Mulinda / Scott, Kirstin W / Bukhman, Alice / Mukherjee, Joia / Rouhani, Shada A

Annals of global health

2023 Volume 89, Issue 1, Page(s) 51

Abstract: Background: The global burden of critical illness falls disproportionately outside high-income countries. Despite younger patient populations with similar or lower disease severity, critical illness outcomes are poor outside high-income countries. A ... ...

Abstract	Background: The global burden of critical illness falls disproportionately outside high-income countries. Despite younger patient populations with similar or lower disease severity, critical illness outcomes are poor outside high-income countries. A lack of data limits attempts to understand and address the drivers of critical care outcomes outside high-income countries. Objectives: We aim to characterize the organization, available resources, and service capacity of public sector critical care units in Malawi and identify barriers to improving care. Methods: We conducted a secondary analysis of the Malawi Emergency and Critical Care Survey, a cross-sectional study performed from January to February 2020 at all four central hospitals and a simple random sample of nine out of 24 public sector district hospitals in Malawi, a predominantly rural, low-income country of 19.6 million in southern Africa. Data from critical care units were used to characterize resources, processes, and barriers to care. Findings: There were four HDUs and four ICUs across the 13 hospitals in the Malawi Emergency and Critical Care Survey sample. The median critical care beds per 1,000,000 catchment was 1.4 (IQR: 0.9 to 6.7). Absent equipment was the most common barrier in HDUs (46% [95% CI: 32% to 60%]). Stockouts was the most common barriers in ICUs (48% [CI: 38% to 58%]). ICUs had a median 3.0 (range: 2 to 8) functional ventilators per unit and reported an ability to perform several quality mechanical ventilation interventions. Conclusions: Although significant gaps exist, Malawian critical care units report the ability to perform several complex clinical processes. Our results highlight regional inequalities in access to care and support the use of process-oriented questions to assess critical care capacity. Future efforts should focus on basic critical care capacity outside of urban areas and quantify the impact of context-specific variables on critical care mortality.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Malawi/epidemiology ; Critical Illness/therapy ; Intensive Care Units ; Critical Care
Language	English
Publishing date	2023-08-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2821756-1
ISSN	2214-9996 ; 2214-9996
ISSN (online)	2214-9996
ISSN	2214-9996
DOI	10.5334/aogh.4053
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Article ; Online: Applying the WHO-ICRC BEC course to train emergency and inpatient healthcare workers in Sierra Leone early in the COVID-19 outbreak.

Sonenthal, Paul D / Kachimanga, Chiyembekezo / Komba, Doris / Bangura, Moses / Ludmer, Nicholas / Lado, Marta / Patino, Marta / Gerrard, Rachel B / Vandy, Matthew J / Marsh, Regan H / Mukherjee, Joia / Rouhani, Shada A

BMC health services research

2022 Volume 22, Issue 1, Page(s) 197

Abstract: Background: Treating critical illness in resource-limited settings during disease outbreaks is feasible and can save lives. Lack of trained healthcare workers is a major barrier to COVID-19 response. There is an urgent need to train healthcare workers ... ...

Abstract	Background: Treating critical illness in resource-limited settings during disease outbreaks is feasible and can save lives. Lack of trained healthcare workers is a major barrier to COVID-19 response. There is an urgent need to train healthcare workers to manage COVID-19. The World Health Organization and International Committee of the Red Cross's Basic Emergency Care course could provide a framework to cross-train personnel for COVID-19 care while strengthening essential health services. Methods: We conducted a prospective cohort study evaluating the Basic Emergency Care course for healthcare workers from emergency and inpatient units at two hospitals in Sierra Leone, a low-income country in West Africa. Baseline, post-course, and six month assessments of knowledge and confidence were completed. Questions on COVID-19 were added at six months. We compared change from baseline in knowledge scores and proportions of participants "very comfortable" with course skills using paired Student's t-tests and McNemar's exact tests, respectively. Results: We enrolled 32 participants of whom 31 completed pre- and post-course assessments. Six month knowledge and confidence assessments were completed by 15 and 20 participants, respectively. Mean knowledge score post-course was 85% (95% CI: 82% to 88%), which was increased from baseline (53%, 48% to 57%, p-value < 0.001). There was sustained improvement from baseline at six months (73%, 67% to 80%, p-value 0.001). The percentage of participants who were "very comfortable" performing skills increased from baseline for 27 of 34 skills post-training and 13 skills at six months. Half of respondents strongly agreed the course improved ability to manage COVID-19. Conclusions: This study demonstrates the feasibility of the Basic Emergency Care course to train emergency and inpatient healthcare workers with lasting impact. The timing of the study, at the beginning of the COVID-19 pandemic, provided an opportunity to illustrate the strategic overlap between building human resource capacity for long-term health systems strengthening and COVID-19. Future efforts should focus on integration with national training curricula and training of the trainers for broader dissemination and implementation at scale.
MeSH term(s)	COVID-19 ; Disease Outbreaks ; Health Personnel ; Humans ; Inpatients ; Pandemics ; Prospective Studies ; SARS-CoV-2 ; Sierra Leone/epidemiology ; World Health Organization
Language	English
Publishing date	2022-02-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-07556-8
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Article ; Online: The Malawi emergency and critical care survey: A cross-sectional national facility assessment.

Sonenthal, Paul D / Nyirenda, Mulinda / Kasomekera, Noel / Marsh, Regan H / Wroe, Emily B / Scott, Kirstin W / Bukhman, Alice / Connolly, Emilia / Minyaliwa, Tadala / Katete, Martha / Banda-Katha, Grace / Mukherjee, Joia S / Rouhani, Shada A

EClinicalMedicine

2022 Volume 44, Page(s) 101245

Abstract: Background: Data on emergency and critical care (ECC) capacity in low-income countries (LICs) are needed to improve outcomes and make progress towards realizing the goal of Universal Health Coverage.: Methods: We developed a novel research instrument ...

Abstract	Background: Data on emergency and critical care (ECC) capacity in low-income countries (LICs) are needed to improve outcomes and make progress towards realizing the goal of Universal Health Coverage. Methods: We developed a novel research instrument to assess public sector ECC capacity and service readiness in LICs. From January 20th to February 18th, 2020 we administered the instrument at all four central hospitals and a simple random sample of nine of 24 district hospitals in Malawi, a landlocked and predominantly rural LIC of 19·1 million people in Southern Africa. The instrument contained questions on the availability of key resources across three domains and was administered to hospital administrators and clinicians from outpatient departments, emergency departments, and inpatient units. Results were used to generate an ECC Readiness Score, with a possible range of 0 to 1, for each facility. Findings: A total of 114 staff members across 13 hospitals completed interviews for this study. Three (33%) district hospitals and all four central hospitals had ECC Readiness Scores above 0·5 ( Interpretation: This is the first study to employ a systematic approach to assessing ECC capacity and service readiness at both district and central hospitals in Malawi and provides a framework for measuring ECC capacity in other LICs. Prior ECC assessments potentially overestimated equipment availability and our methodology may provide a more accurate approach. There is an urgent need for investments in ECC services, particularly at district hospitals which are more accessible to Malawi's predominantly rural population. These findings highlight the need for long-term investments in health systems strengthening and underscore the importance of understanding capacity in LIC settings to inform these efforts. Funding: Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Department of Emergency Medicine, Brigham and Women's Hospital.
Language	English
Publishing date	2022-01-13
Publishing country	England
Document type	Journal Article
ISSN	2589-5370
ISSN (online)	2589-5370
DOI	10.1016/j.eclinm.2021.101245
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Article ; Online: Combating information chaos: a case for collaborative clinical guidelines in a pandemic.

Cohen, C Lee / Walker, Katherine H / Hsiang, Mina / Sonenthal, Paul D / Riviello, Elisabeth D / Rouhani, Shada A / Lipnick, Michael S / Merriam, Louis T / Kim, Edy Y

Cell reports. Medicine

2021 Volume 2, Issue 8, Page(s) 100375

Abstract: The speed and scale of new information during the COVID-19 pandemic required a new approach toward developing best practices and evidence-based clinical guidance. To address this need, we produced COVIDProtocols.org, a collaborative, evidence-based, ... ...

Abstract	The speed and scale of new information during the COVID-19 pandemic required a new approach toward developing best practices and evidence-based clinical guidance. To address this need, we produced COVIDProtocols.org, a collaborative, evidence-based, digital platform for the development and dissemination of COVID-19 clinical guidelines that has been used by over 500,000 people from 196 countries. We use a Collaborative Writing Application (CWA) to facilitate an expedited expert review process and a web platform that deploys content directly from the CWA to minimize any delays. Over 200 contributors have volunteered to create open creative-commons content that spans over 30 specialties and medical disciplines. Multiple local and national governments, hospitals, and clinics have used the site as a key resource for their own clinical guideline development. COVIDprotocols.org represents a model for efficiently launching open-access clinical guidelines during crisis situations to share expertise and combat misinformation.
MeSH term(s)	COVID-19/therapy ; COVID-19/transmission ; Evidence-Based Practice/methods ; Humans ; Information Dissemination/methods ; Pandemics/prevention & control ; Practice Guidelines as Topic/standards ; SARS-CoV-2/pathogenicity
Language	English
Publishing date	2021-07-27
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2666-3791
ISSN (online)	2666-3791
DOI	10.1016/j.xcrm.2021.100375
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Article ; Online: Evaluation of emergency care education and triage implementation: an observational study at a hospital in rural Liberia.

Towns, Kathleen / Dolo, Isaac / Pickering, Ashley E / Ludmer, Nicholas / Karanja, Viola / Marsh, Regan H / Horace, Minnie / Dweh, Denny / Dalieh, Tresa / Myers, Sharon / Bukhman, Alice / Gashi, Jason / Sonenthal, Paul / Ulysse, Patrick / Cook, Rebecca / Rouhani, Shada A

BMJ open

2023 Volume 13, Issue 5, Page(s) e067343

Abstract: Introduction: In Liberia, emergency care is still in its early development. In 2019, two emergency care and triage education sessions were done at J. J. Dossen Hospital in Southeastern Liberia. The observational study objectives evaluated key process ... ...

Abstract	Introduction: In Liberia, emergency care is still in its early development. In 2019, two emergency care and triage education sessions were done at J. J. Dossen Hospital in Southeastern Liberia. The observational study objectives evaluated key process outcomes before and after the educational interventions. Methods: Emergency department paper records from 1 February 2019 to 31 December 2019 were retrospectively reviewed. Simple descriptive statistics were used to describe patient demographics and χ Results: There were 8222 patient visits recorded that were included in our analysis. Patients in the post-intervention 1 group had higher odds of having a documented full set of vital signs compared with the baseline group (16% vs 3.5%, OR: 5.4 (95% CI: 4.3 to 6.7)). After triage implementation, patients who were triaged were 16 times more likely to have a full set of vitals compared with those who were not triaged. Similarly, compared with the baseline group, patients in the post-intervention 1 group had higher odds of having a glucose documented if they presented with altered mental status or a neurologic complaint (37% vs 30%, OR: 1.7 (95% CI: 1.3 to 2.2)), documented antibiotic administration if they had a presumed bacterial infection (87% vs 35%, OR: 12.8 (95% CI: 8.8 to 17.1)), documented malaria test if presenting with fever (76% vs 61%, OR: 2.05 (95% CI: 1.37 to 3.08)) or documented repeat set of vitals if presenting with shock (25% vs 6.6%, OR: 8.85 (95% CI: 1.67 to 14.06)). There was no significant difference in the above process outcomes between the education interventions. Conclusion: This study showed improvement in most process measures between the baseline and post-intervention 1 groups, benefits that persisted post-intervention 2, thus supporting the importance of short-course education interventions to durably improve facility-based care.
MeSH term(s)	Humans ; Retrospective Studies ; Liberia/epidemiology ; Triage ; Emergency Medical Services ; Emergency Service, Hospital ; Hospitals
Language	English
Publishing date	2023-05-18
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-067343
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Article ; Online: Applying the WHO-ICRC BEC course to train emergency and inpatient healthcare workers in Sierra Leone early in the COVID-19 outbreak

Paul D Sonenthal / Chiyembekezo Kachimanga / Doris Komba / Moses Bangura / Nicholas Ludmer / Marta Lado / Marta Patino / Rachel B Gerrard / Matthew J Vandy / Regan H Marsh / Joia Mukherjee / Shada A Rouhani

BMC Health Services Research, Vol 22, Iss 1, Pp 1-

2022 Volume 11

Abstract: Abstract Background Treating critical illness in resource-limited settings during disease outbreaks is feasible and can save lives. Lack of trained healthcare workers is a major barrier to COVID-19 response. There is an urgent need to train healthcare ... ...

Abstract	Abstract Background Treating critical illness in resource-limited settings during disease outbreaks is feasible and can save lives. Lack of trained healthcare workers is a major barrier to COVID-19 response. There is an urgent need to train healthcare workers to manage COVID-19. The World Health Organization and International Committee of the Red Cross’s Basic Emergency Care course could provide a framework to cross-train personnel for COVID-19 care while strengthening essential health services. Methods We conducted a prospective cohort study evaluating the Basic Emergency Care course for healthcare workers from emergency and inpatient units at two hospitals in Sierra Leone, a low-income country in West Africa. Baseline, post-course, and six month assessments of knowledge and confidence were completed. Questions on COVID-19 were added at six months. We compared change from baseline in knowledge scores and proportions of participants “very comfortable” with course skills using paired Student’s t-tests and McNemar’s exact tests, respectively. Results We enrolled 32 participants of whom 31 completed pre- and post-course assessments. Six month knowledge and confidence assessments were completed by 15 and 20 participants, respectively. Mean knowledge score post-course was 85% (95% CI: 82% to 88%), which was increased from baseline (53%, 48% to 57%, p-value < 0.001). There was sustained improvement from baseline at six months (73%, 67% to 80%, p-value 0.001). The percentage of participants who were “very comfortable” performing skills increased from baseline for 27 of 34 skills post-training and 13 skills at six months. Half of respondents strongly agreed the course improved ability to manage COVID-19. Conclusions This study demonstrates the feasibility of the Basic Emergency Care course to train emergency and inpatient healthcare workers with lasting impact. The timing of the study, at the beginning of the COVID-19 pandemic, provided an opportunity to illustrate the strategic overlap between building human ...
Keywords	Emergency and critical care ; COVID-19 ; Basic emergency care course ; Capacity building ; Training ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article ; Online: The Malawi emergency and critical care survey

Paul D. Sonenthal / Mulinda Nyirenda / Noel Kasomekera / Regan H. Marsh / Emily B. Wroe / Kirstin W. Scott / Alice Bukhman / Emilia Connolly / Tadala Minyaliwa / Martha Katete / Grace Banda-Katha / Joia S. Mukherjee / Shada A. Rouhani

EClinicalMedicine, Vol 44, Iss , Pp 101245- (2022)

A cross-sectional national facility assessment

2022

Abstract: Summary: Background: Data on emergency and critical care (ECC) capacity in low-income countries (LICs) are needed to improve outcomes and make progress towards realizing the goal of Universal Health Coverage. Methods: We developed a novel research ... ...

Abstract	Summary: Background: Data on emergency and critical care (ECC) capacity in low-income countries (LICs) are needed to improve outcomes and make progress towards realizing the goal of Universal Health Coverage. Methods: We developed a novel research instrument to assess public sector ECC capacity and service readiness in LICs. From January 20th to February 18th, 2020 we administered the instrument at all four central hospitals and a simple random sample of nine of 24 district hospitals in Malawi, a landlocked and predominantly rural LIC of 19·1 million people in Southern Africa. The instrument contained questions on the availability of key resources across three domains and was administered to hospital administrators and clinicians from outpatient departments, emergency departments, and inpatient units. Results were used to generate an ECC Readiness Score, with a possible range of 0 to 1, for each facility. Findings: A total of 114 staff members across 13 hospitals completed interviews for this study. Three (33%) district hospitals and all four central hospitals had ECC Readiness Scores above 0·5 (p-value 0·070). Absent equipment was identified as the most common barrier to ECC Readiness. Central hospitals had higher median ECC Readiness Scores with less variability 0·82 (interquartile range: 0·80–0·89) than district hospitals (0·33, 0·23 to 0·50, p-value 0·021). Interpretation: This is the first study to employ a systematic approach to assessing ECC capacity and service readiness at both district and central hospitals in Malawi and provides a framework for measuring ECC capacity in other LICs. Prior ECC assessments potentially overestimated equipment availability and our methodology may provide a more accurate approach. There is an urgent need for investments in ECC services, particularly at district hospitals which are more accessible to Malawi's predominantly rural population. These findings highlight the need for long-term investments in health systems strengthening and underscore the importance of ...
Keywords	Emergency and critical care ; Intensive care ; Health systems strengthening ; Malawi ; Service readiness ; Universal health coverage ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
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Article ; Online: COVID-19 preparedness in Malawi: a national facility-based critical care assessment.

Sonenthal, Paul D / Masiye, Jones / Kasomekera, Noel / Marsh, Regan H / Wroe, Emily B / Scott, Kirstin W / Li, Ruoran / Murray, Megan B / Bukhman, Alice / Connolly, Emilia / Minyaliwa, Tadala / Katete, Martha / Banda, Grace / Nyirenda, Mulinda / Rouhani, Shada A

The Lancet. Global health

2020 Volume 8, Issue 7, Page(s) e890–e892

MeSH term(s)	COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Critical Care/organization & administration ; Health Facilities ; Humans ; Malawi/epidemiology ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control
Keywords	covid19
Language	English
Publishing date	2020-05-25
Publishing country	England
Document type	Letter ; Research Support, Non-U.S. Gov't
ZDB-ID	2723488-5
ISSN	2214-109X ; 2214-109X
ISSN (online)	2214-109X
ISSN	2214-109X
DOI	10.1016/S2214-109X(20)30250-3
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