赞比亚公立医院应急医疗能力的横断面评估。

Cross-sectional evaluation of emergency care capacity at public hospitals in Zambia.

机构信息

Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa.

Emory University School of Public Health, Atlanta, Georgia, USA.

出版信息

Emerg Med J. 2019 Oct;36(10):620-624. doi: 10.1136/emermed-2018-207465. Epub 2019 Jul 10.

DOI:10.1136/emermed-2018-207465

PMID:31292206

Abstract

OBJECTIVES

The last decade has seen rapid expansion of emergency care systems across Africa, although they remain underdeveloped. In Zambia, the Ministry of Health has taken interest in improving the situation and data are needed to appropriately guide system strengthening efforts. The Emergency Care Assessment Tool (ECAT) provides a context-specific means of measuring capacity of healthcare facilities in low- and middle-income countries. We evaluated Zambian public hospitals using the ECAT to inform resource-effective improvements to the nation's healthcare system.

METHODS

The ECAT was administered to the lead clinician in the emergency unit at 23 randomly sampled public hospitals across seven of Zambia's 10 provinces in March 2016. Data were collected regarding hospitals' perceived abilities to perform a number of predefined signal functions - life-saving procedures that encompass the need for both skills and resources. Signal functions (36 for intermediate facilities, 51 for advanced) related to six sentinel conditions that represent a large burden of morbidity and mortality from emergencies. We report the proportion of procedures that each level of hospital was capable of, along with barriers to delivery of care.

RESULTS

Across all hospitals, most of the level-appropriate emergency care procedures could be performed. Intermediate level (district) hospitals were able to perform 75% (95% CI 73.2 to 76.8) of signal functions for the six conditions. Among advanced level hospitals, provincial hospitals were able to perform 68.6% (67.4% to 69.7%) and central hospitals 96.1% (95% CI 93.5 to 98.7) Main failures in delivery of care were attributed to a lack of healthcare worker training and availability of consumable resources, such as medicines or supplies.

CONCLUSION

Zambian public hospitals have reasonable capacity to care for acutely ill and injured patients; however, there is a need for increased training and improved supply chains.

摘要

目的

过去十年，非洲各地的急救护理系统迅速扩张，尽管这些系统仍欠发达。赞比亚卫生部对改善这种情况很感兴趣，需要数据来适当指导系统加强工作。急救护理评估工具（ECAT）提供了一种特定于情境的方法来衡量中低收入国家医疗保健设施的能力。我们使用 ECAT 评估赞比亚公立医院，为国家医疗系统的资源有效改善提供信息。

方法

2016 年 3 月，在赞比亚 10 个省中的 7 个省的 23 家随机抽样公立医院的急诊单元中，向急诊科室的主治医生施测 ECAT。收集有关医院执行多项预定信号功能能力的数据——包含技能和资源需求的救生程序。信号功能（中级设施 36 项，高级设施 51 项）与六种代表紧急情况发病率和死亡率负担很大的哨兵疾病有关。我们报告每个医院级别能够执行的程序比例，以及提供护理的障碍。

结果

在所有医院中，大多数适当级别的紧急护理程序都可以进行。中级（区）医院能够执行 6 种疾病的 75%（95%置信区间 73.2 至 76.8）的信号功能。在高级医院中，省级医院能够执行 68.6%（67.4%至 69.7%），而中央医院能够执行 96.1%（95%置信区间 93.5%至 98.7%）。护理提供方面的主要失败归因于医护人员培训和消耗性资源（如药品或用品）的缺乏。