Pillay Shivani, Hoffman Deidre, Parris Pano
Division of Emergency Medicine, University of Witwatersrand, Johannesburg, South Africa.
Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
Afr J Emerg Med. 2022 Dec;12(4):406-409. doi: 10.1016/j.afjem.2022.08.002. Epub 2022 Sep 15.
In-hospital advanced life support and acute airway management is critically time sensitive and requires the immediate availability of key equipment. While most acute airway emergencies present to emergency centres, clinical deterioration may occur at any point during a patient's care process. Thus, all areas of the hospital should be equipped to provide acute airway management. The aim of this study was to audit the availability and functioning of emergency airway equipment and drugs at a large academic Johannesburg hospital.
A prospective, observational, cross-sectional spot audit was conducted at nineteen patient care units at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, SA from January to March 2018. Using a modified list of equipment and drugs derived from the EMSSA Practice Guideline of Rapid Sequence Intubation, each unit's emergency trolley was spot audited by a single Investigator, assessing both availability and if the equipment was in good working order. A selection of drugs was assessed for availability and location.
Overall, approximately two thirds (67%) of the listed equipment were available and in working order in the audited units. Almost a third (31%) of the listed equipment was not available at all, while 2% of the equipment was available but not working. The Intensive Care Unit, Medical Emergency Unit and Trauma Unit had the highest (≥80%) of available and working equipment, with the Psychiatry Ward and the Labour Ward having the lowest percentage (≤45%).
This audit highlights specific deficiencies in emergency airway management equipment within this institution, as well as the need for improved strategies to address equipment shortages. The causes for these shortages were not explored. Recommendations following this audit include further qualitative research to explore and address the barriers to well stocked emergency trolleys, the standardization of equipment checklists and to provide regular staff training in resuscitation.
医院内的高级生命支持和急性气道管理对时间要求极为严格，需要关键设备随时可用。虽然大多数急性气道紧急情况发生在急诊中心，但患者护理过程中的任何时候都可能出现临床病情恶化。因此，医院的所有区域都应具备提供急性气道管理的能力。本研究的目的是对约翰内斯堡一家大型学术医院的紧急气道设备和药物的可用性及功能进行审计。
2018年1月至3月，在南非约翰内斯堡克里斯·哈尼·巴拉干纳特学术医院（CHBAH）的19个患者护理单元进行了一项前瞻性、观察性、横断面现场审计。使用从EMSSA快速顺序插管实践指南衍生而来的经过修改的设备和药物清单，由一名调查员对每个单元的急救推车进行现场审计，评估设备的可用性以及是否处于良好工作状态。对选定的药物进行可用性和存放位置评估。
总体而言，在接受审计的单元中，约三分之二（67%）的列出设备可用且能正常工作。近三分之一（31%）的列出设备根本不可用，而2%的设备可用但无法正常工作。重症监护病房、医疗急诊单元和创伤单元可用且能正常工作的设备比例最高（≥80%），精神科病房和产房的比例最低（≤45%）。
本次审计突出了该机构内紧急气道管理设备存在的具体不足，以及需要改进解决设备短缺问题的策略。未探究这些短缺的原因。本次审计后的建议包括进一步进行定性研究，以探索和解决急救推车储备充足的障碍、设备清单的标准化以及定期为工作人员提供复苏培训。
