Forson Paa, Owusu Richard, Oduro George, Donkor Peter, Mock Charles
St Patrick's Hospital, Offinso, Ghana.
Jhpiego Corporation, Accra, Ghana.
Afr J Emerg Med. 2025 Sep;15(3):100880. doi: 10.1016/j.afjem.2025.05.004. Epub 2025 Jun 3.
Quality of off-hours care (nights, weekends) for many emergency conditions frequently proves inadequate. Most studies on this topic are from high-income countries. Given existing resource restrictions in low- and middle-income countries, it is especially relevant to know how care is impacted during off-hours, when resources are usually less. We assessed differences in quality indicators of emergency care between on- and off-hours at two district hospitals.
In this prospective cohort study conducted from June 2021 to May 2023, patients presenting to the emergency unit between 8 AM and 8 PM on weekdays were categorized as presenting during on-hours. Those presenting between 8 PM and 8 AM or anytime on weekends were considered off-hours. Completion of 16 quality indicators was compared between patients who received care during on- and off-hours.
Data were gathered on 7831 patients: 5019 (64.1 %) presenting during on-hours and 2812 (35.9 %) during off-hours. Overall achievement of quality indicators ranged from 27.1 % (recording GCS) to 98.3 % (documentation of diagnosis). Twelve indicators were performed in <80 % of patients. Four indicators were performed more often during on-hours: primary survey for trauma patients; blood glucose; documentation of diagnosis; and Glasgow Coma Scale. Three indicators were performed more often during off-hours: splinting of long-bone fractures; analgesics given to patients reporting pain; and recording of complete initial vital signs. Although there were significant differences in seven indicators, differences were small (<10 %) in six.
There were limited differences in performance of quality indicators between on- and off-hours, indicating a general consistency of quality of care across daily and weekly cycles. However, most indicators were performed in <80 % of patients. Monitoring of quality indicators of emergency care should be done more consistently as a way to standardise care and improve patient outcomes.
许多紧急情况的非工作时间（夜间、周末）护理质量常常被证明是不足的。关于这个主题的大多数研究来自高收入国家。鉴于低收入和中等收入国家现有的资源限制，了解在资源通常较少的非工作时间护理是如何受到影响的尤为重要。我们评估了两家区级医院工作时间和非工作时间的急诊护理质量指标差异。
在这项于2021年6月至2023年5月进行的前瞻性队列研究中，工作日上午8点至晚上8点到急诊科就诊的患者被归类为在工作时间就诊。晚上8点至上午8点或周末任何时间就诊的患者被视为非工作时间就诊。比较了在工作时间和非工作时间接受护理的患者之间16项质量指标的完成情况。
收集了7831名患者的数据：5019名（64.1%）在工作时间就诊，2812名（35.9%）在非工作时间就诊。质量指标的总体完成率从27.1%（记录格拉斯哥昏迷量表）到98.3%（诊断记录）不等。12项指标在不到80%的患者中进行。4项指标在工作时间更常进行：创伤患者的初步检查；血糖；诊断记录；以及格拉斯哥昏迷量表。3项指标在非工作时间更常进行：长骨骨折固定；给报告疼痛的患者使用镇痛药；以及完整记录初始生命体征。虽然7项指标存在显著差异，但6项指标的差异较小（<10%）。
工作时间和非工作时间质量指标的执行情况差异有限，表明日常和每周周期内护理质量总体一致。然而，大多数指标在不到80%的患者中进行。应更持续地监测急诊护理质量指标，作为规范护理和改善患者结局的一种方式。
