Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States of America.
Department of Emergency Medicine, University of Southern California, Los Angeles, CA, United States of America.
PLoS One. 2023 Mar 15;18(3):e0282690. doi: 10.1371/journal.pone.0282690. eCollection 2023.
Emergency care is vital in low- and middle-income countries (LMICs) but many frontline healthcare workers in low-resource settings have no formal training in emergency care. To address this gap, the World Health Organization (WHO) developed Basic Emergency Care (BEC): Approach to the acutely ill and injured, a multi-day, open-source course for healthcare workers in low-resource settings. Building on the BEC foundation, this study uses an implementation science (IS) lens to develop, implement, and evaluate a comprehensive emergency care curriculum in a single emergency facility in Liberia.
A six-month emergency care curriculum consisting of BEC content, standardized WHO clinical documentation forms, African Federation of Emergency Medicine (AFEM) didactics, and clinical mentorship by visiting emergency medicine (EM) faculty was designed and implemented using IS frameworks at Redemption Hospital, a low-resource public referral hospital in Monrovia, the capital of Liberia. Healthcare worker performance on validated knowledge-based exams during pre- and post-intervention testing, post-course surveys, and patient outcomes were used to evaluate the program.
Nine visiting EM physicians provided 1400 hours of clinical mentorship and 560 hours of didactic training to fifty-six Redemption Hospital staff over six-months. Median test scores improved 20.0% (p<0.001) among the forty-three healthcare workers who took both the pre- and post-intervention tests. Participants reported increased confidence in caring for medical and trauma patients and comfort performing emergency care tasks on post-course surveys. Emergency unit (EU)/Isolation unit (IU) mortality decreased during the six-month implementation period, albeit non-significantly. Course satisfaction was high across multiple domains.
This study builds on prior research supporting WHO efforts to improve emergency care globally. BEC implementation over a six-month timeframe using IS principles is an effective alternative strategy for facilities in resource-constrained environments wishing to strengthen emergency care delivery.
在中低收入国家（LMICs），紧急护理至关重要，但许多资源匮乏环境中的一线医护人员没有接受过紧急护理的正规培训。为了弥补这一差距，世界卫生组织（WHO）开发了基本紧急护理（BEC）：对急性病和伤员的处理方法，这是一门为资源匮乏环境中的医护人员开设的为期多日的开源课程。本研究以实施科学（IS）的视角为基础，在利比里亚的一家单一急救机构中开发、实施和评估了一套全面的急救护理课程，以此为 BEC 奠定基础。
在利比里亚首都蒙罗维亚的一家资源匮乏的公立转诊医院——救赎医院，我们使用 IS 框架设计并实施了一项为期六个月的急救护理课程，内容包括 BEC 课程、标准化的世卫组织临床文件表格、非洲急诊医学联合会（AFEM）的教学方法以及由来访的急诊医学（EM）教员提供的临床指导。我们使用了医护人员在干预前后的测试、课程结束后的调查和患者结果中的基于验证的知识考试成绩来评估该项目。
在六个月的时间里，九名来访的 EM 医生为 56 名救赎医院的员工提供了 1400 小时的临床指导和 560 小时的教学培训。在参加了干预前后测试的 43 名医护人员中，中位数测试成绩提高了 20.0%（p<0.001）。参与者在课程结束后的调查中报告说，他们对照顾内科和创伤患者的信心增强了，对执行急救护理任务的舒适度也提高了。在六个月的实施期间，急救单元（EU）/隔离单元（IU）的死亡率有所下降，尽管没有显著意义。课程满意度在多个领域都很高。
本研究是对 WHO 全球改善急救护理工作的努力的支持。在资源有限的环境中，使用 IS 原则在六个月的时间内实施 BEC 是一种有效的替代策略，可以加强急救护理服务。
