Dresser Caleb, Periyanayagam Usha, Dreifuss Brad, Wangoda Robert, Luyimbaazi Julius, Bisanzo Mark
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 120 Peterborough St Apt #4, Boston, MA, 02215, USA.
Global Emergency Care Collaborative, Kampala, Uganda.
World J Surg. 2017 Sep;41(9):2193-2199. doi: 10.1007/s00268-017-4014-7.
Acute surgical care services in rural Sub-Saharan Africa suffer from human resource and systemic constraints. Developing emergency care systems and task sharing aspects of acute surgical care addresses many of these issues. This paper investigates the degree to which specialized non-physicians practicing in a dedicated Emergency Department contribute to the effective and efficient management of acute surgical patients.
This is a retrospective review of an electronic quality assurance database of patients presenting to an Emergency Department in rural Uganda staffed by non-physician clinicians trained in emergency care. Relevant de-identified clinical data on patients admitted directly to the operating theater from 2011 to 2014 were analyzed in Microsoft Excel.
Overall, 112 Emergency Department patients were included in the analysis and 96% received some form of laboratory testing, imaging, medication, or procedure in the ED, prior to surgery. 72% of surgical patients referred by ED received preoperative antibiotics, and preoperative fluid resuscitation was initiated in 65%. Disposition to operating theater was accomplished within 3 h of presentation for 73% of patients. 79% were successfully followed up to assess outcomes at 72 h. 92% of those with successful follow-up reported improvement in their clinical condition. The confirmed mortality rate was 5%.
Specialized non-physician clinicians practicing in a dedicated Emergency Department can perform resuscitation, bedside imaging and laboratory studies to aid in diagnosis of acute surgical patients and arrange transfer to an operating theater in an efficient fashion. This model has the potential to sustainably address structural and human resources problems inherent to Sub-Saharan Africa's current acute surgical care model and will benefit from further study and expansion.
撒哈拉以南非洲农村地区的急性外科护理服务面临人力资源和系统方面的限制。发展急诊护理系统以及急性外科护理中的任务分担可解决其中许多问题。本文调查了在专门的急诊科执业的专业非医师人员对急性外科患者进行有效管理的程度。
这是一项对乌干达农村地区一家由接受过急诊护理培训的非医师临床医生配备人员的急诊科患者电子质量保证数据库的回顾性研究。在Microsoft Excel中分析了2011年至2014年直接收入手术室的患者的相关匿名临床数据。
总体而言，112名急诊科患者纳入分析，96%的患者在手术前在急诊科接受了某种形式的实验室检查、影像学检查、药物治疗或操作。急诊科转诊的外科患者中有72%接受了术前抗生素治疗，65%开始了术前液体复苏。73%的患者在就诊后3小时内被送往手术室。79%的患者在72小时时成功接受随访以评估结果。成功随访的患者中有92%报告临床状况有所改善。确诊死亡率为5%。
在专门的急诊科执业的专业非医师临床医生可以进行复苏、床边影像学检查和实验室研究，以帮助诊断急性外科患者，并以高效的方式安排转至手术室。这种模式有可能可持续地解决撒哈拉以南非洲当前急性外科护理模式固有的结构和人力资源问题，并且将受益于进一步的研究和推广。
