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  1. Article ; Online: Impact of Care Initiation Model on Emergency Department Orders and Operational Metrics

    Andy Hung-Yi Lee / Rebecca E. Cash / Alice Bukhman / Dana Im / Damarcus Baymon / Leon D. Sanchez / Paul C. Chen

    Western Journal of Emergency Medicine, Vol 24, Iss

    Cohort Study

    2023  Volume 4

    Abstract: Introduction: Emergency departments (ED) employ many strategies to address crowding and prolonged wait times. They include front-end Care Initiation and clinician-in-triage models that start the diagnostic and therapeutic process while the patient waits ... ...

    Abstract Introduction: Emergency departments (ED) employ many strategies to address crowding and prolonged wait times. They include front-end Care Initiation and clinician-in-triage models that start the diagnostic and therapeutic process while the patient waits for a care space in the ED. The objective of this study was to quantify the impact of a Care Initiation model on resource utilization and operational metrics in the ED. Methods: We performed a retrospective analysis of ED visits at our institution during October 2021. Baseline characteristics were compared with Chi-square and quantile regression. We used t-tests to calculate unadjusted difference in outcome measures, including number of laboratory tests ordered and average time patients spent in the waiting room and the ED treatment room, and the time from arrival until ED disposition. We performed propensity score analysis using matching and inverse probability weighting to quantify the direct impact of Care Initiation on outcome measures. Results: There were 2,407 ED patient encounters, 1,191 (49%) of whom arrived during the hours when Care Initiation was active. A total of 811 (68%) of these patients underwent Care Initiation, while the remainder proceeded directly to the main treatment area. Patients were more likely to undergo Care Initiation if they had lower acuity and lower risk of admission, and if the ED was busier as measured by the number of recent arrivals and percentage of occupied ED beds. After adjusting for patient-specific and department-level covariates, Care Initiation did not increase the number of diagnostic laboratory tests ordered. Care Initiation was associated with increased waiting room time by 1.8 hours and longer time from arrival until disposition by 1.3 hours, but with decreased time in the main treatment area by 0.6 hours, which represents a 15% reduction. Conclusion: Care Initiation was associated with a 15% reduction in time spent in the main ED treatment area but longer waiting room time and longer time until ED disposition ...
    Keywords Medicine ; R ; Medical emergencies. Critical care. Intensive care. First aid ; RC86-88.9
    Subject code 650
    Language English
    Publishing date 2023-06-01T00:00:00Z
    Publisher eScholarship Publishing, University of California
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Health system capacity to manage diabetic ketoacidosis in nine low-income and lower-middle income countries

    Sarah Matthews / Matthew M. Coates / Alice Bukhman / Celina Trujillo / Gina Ferrari / Wubaye Walelgne Dagnaw / Darius Leopold Fénelon / Theodros Getachew / Biraj Karmacharya / Nancy Charles Larco / Aimée M. Lulebo / Mary Theodory Mayige / Maïmouna Ndour Mbaye / Getahun Tarekegn / Neil Gupta / Alma Adler / Gene Bukhman

    EClinicalMedicine, Vol 55, Iss , Pp 101759- (2023)

    A cross-sectional analysis of nationally representative survey dataResearch in context

    1480  

    Abstract: Summary: Background: There has been increasing awareness about the importance of type 1 diabetes (T1D) globally. Diabetic ketoacidosis (DKA) is a life-threatening complication of T1D in low-income settings. Little is known about health system capacity to ...

    Abstract Summary: Background: There has been increasing awareness about the importance of type 1 diabetes (T1D) globally. Diabetic ketoacidosis (DKA) is a life-threatening complication of T1D in low-income settings. Little is known about health system capacity to manage DKA in low- and lower-middle income countries (LLMICs). As such, we describe health system capacity to diagnose and manage DKA across nine LLMICs using data from Service Provision Assessments. Methods: In this cross-sectional study, we used data from Service Provision Assessment (SPA) surveys, which are part of the Demographic and Health Survey (DHS) Program. We defined an item set to diagnose and manage DKA in higher-level (tertiary or secondary) facilities, and a set to assess and refer patients presenting to lower-level (primary) facilities. We quantified each item's availability by service level in Bangladesh (Survey 1: May 22 2014–Jul 20 2014; Survey 2: Jul 2017–Oct 2017), the Democratic Republic of the Congo (DRC) (Oct 16 2017–Nov 24 2017 in Kinshasha; Aug 08 2018–Apr 20 2018 in rest of country), Haiti (Survey 1: Mar 05 2013–Jul 2013; Survey 2: Dec 16 2017–May 09 2018), Ethiopia (Feb 06 2014–Mar 09 2014), Malawi (Phase 1: Jun 11 2013–Aug 20 2013; Phase 2: Nov 13 2013–Feb 7 2014), Nepal (Phase 1: Apr 20 2015–Apr 25 2015; Phase 2: Jun 04 2015–Nov 05 2015), Senegal (Survey 1: Jan 2014–Oct 2014; Survey 2: Feb 09 2015–Nov 10 2015; Survey 3: Feb 2016–Nov 2016; Survey 4: Mar 13 2017–Dec 15 2017; Survey 5: Apr 15 2018–Dec 31 2018; Survey 6: Apr 15 2019–Feb 28 2020), Tanzania (Oct 20 2014–Feb 21 2015), and Afghanistan (Nov 1 2018–Jan 20 2019). Variation in secondary facilities’ capacity and trends over time were also explored. Findings: We examined data from 2028 higher-level and 7534 lower-level facilities. Of these, 1874 higher-level and 6636 lower-level facilities’ data were eligible for analysis. Availability of all item sets were low at higher-level facilities, where less than 50% had the minimal set of supplies, less than 20% had the full minimal set, ...
    Keywords Type 1 diabetes ; Ketoacidosis ; Africa ; Low-income countries ; Lower-middle income countries ; Health systems ; Medicine (General) ; R5-920
    Subject code 300
    Language English
    Publishing date 2023-01-01T00:00:00Z
    Publisher Elsevier
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Evaluation of emergency care education and triage implementation

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

    BMJ Open, Vol 13, Iss

    an observational study at a hospital in rural Liberia

    2023  Volume 5

    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 χ2 analyses were used to test for significance. ORs were calculated for key predetermined process measures.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.
    Keywords Medicine ; R
    Subject code 796
    Language English
    Publishing date 2023-05-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. 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
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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    Inter-library loan at ZB MED

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