Bredow Zosia, Corbett Zoe, Tarawally Moses Mohamed, Jackson Lucy, Mansaray Foday Tejan, Sesay Santigie, Leather Andrew
King's Global Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK.
Kenema Government Hospital, Kenema, Sierra Leone.
Afr J Emerg Med. 2024 Mar;14(1):58-64. doi: 10.1016/j.afjem.2024.01.003. Epub 2024 Feb 6.
The Disease Control Priorities Project estimates that over 50 % of annual mortality in low- and middle-income countries can be addressed by improved emergency care. Sierra Leone's Ministry of Health and Sanitation has highlighted emergency care as a national priority. We conducted the first multicentre analysis of emergency care capacity in Sierra Leone, using the Hospital Emergency Unit Assessment Tool (HEAT) to analyse 14 government hospitals across the country.
HEAT is a standardised assessment that is recommended in the World Health Organisation Emergency Care Toolkit. It has been used comparably elsewhere. To analyse Sierra Leone's emergency care capacity with the HEAT data, we created the HEAT-adjusted Emergency Care Capacity Score. Purposeful sampling was used to select 14 government facilities nationwide. A multidisciplinary team was interviewed over a 2-day in-person visit to each facility.
Human Resources was the strongest parameter, scoring 49 %. All hospitals provided emergency cover 24/7. Emergency Diagnostic Services was the most severely limited parameter, scoring 29 %. 3 hospitals had no access to basic radiography. Infrastructure scored 47 %. 2 hospitals had adequate electricity supply; 5 had adequate clean, running water. No hospitals had adequate oxygen supply. Clinical services scored 39 %. 10 hospitals had no designated Emergency Unit, only 2 triaged to stratify severity. Signal functions scored 38 %. No hospitals had reliable access to emergency drugs such as adrenaline. The total HEAT-adjusted Emergency Care Capacity Score across all hospitals was 40 %.
These data identify gaps that have already led to local interventions, including focussing emergency resources to a resuscitation area, and training multidisciplinary teams in emergency care skills. This facility-level analysis could feed into wider assessment of Sierra Leone's emergency care systems at every level, which may help prioritise government strategy to target sustainable strengthening of national emergency care.
疾病控制优先项目估计，在低收入和中等收入国家，超过50%的年度死亡可通过改善急诊护理来解决。塞拉利昂卫生与环境部已将急诊护理列为国家优先事项。我们使用医院急诊室评估工具（HEAT）对该国14家政府医院进行分析，开展了塞拉利昂急诊护理能力的首次多中心分析。
HEAT是世界卫生组织急诊护理工具包中推荐的标准化评估工具，已在其他地方进行过类似使用。为通过HEAT数据分析塞拉利昂的急诊护理能力，我们创建了经HEAT调整的急诊护理能力得分。采用目的抽样法在全国范围内选取了14家政府设施。一个多学科团队在对每个设施进行为期两天的实地访问期间接受了访谈。
人力资源是最强的参数，得分为49%。所有医院均提供全天候急诊服务。急诊诊断服务是最严重受限的参数，得分为29%。3家医院无法进行基本的X光检查。基础设施得分为%。2家医院有充足的电力供应；5家有充足的清洁自来水。没有医院有充足的氧气供应。临床服务得分为39%。10家医院没有指定的急诊室，只有2家进行了分诊以区分严重程度。信号功能得分为38%。没有医院能可靠地获取肾上腺素等急救药物。所有医院经HEAT调整后的急诊护理能力总得分是40%。
这些数据揭示了已导致当地采取干预措施的差距，包括将急诊资源集中到复苏区域，以及对多学科团队进行急诊护理技能培训。这种机构层面的分析可纳入对塞拉利昂各级急诊护理系统的更广泛评估，这可能有助于确定政府战略的优先事项，以实现对国家急诊护理的可持续加强目标。
