Ujuzi (Practical Pearl/Perle Pratique)

Ujuzi means skills in Swahili and is intended to be a regular feature for colleagues to share practical interventions, innovations and novelties that have proved useful in the management of patients in the prehospital environment or Emergency Centre. You can let Ujuzi know about your practical ideas by emailing [email protected]

Ujuzi (Practical Pearl/Perle Pratique)

Ujuzi means skills in Swahili and is intended to be a regular feature for colleagues to share practical interventions, innovations and novelties that have proved useful in the management of patients in the prehospital environment or Emergency Centre. You can let Ujuzi know about your practical ideas by emailing [email protected]

Comparative trend analysis of gunshot injuries and motor vehicle crashes at the KATH Emergency Department

Motor vehicle crashes are a major cause of morbidity and mortality in developing countries. Injuries resulting from fire arms were the second leading cause of death in the US in 2003. In Ghana, motor vehicle crashes (MVC) are a common cause of injury and mortality whiles firearm related injuries (FAI) have not featured highly. However, with increase in commercial and industrial activities in Ghana, firearm related injuries have been on the increase. This study seeks to compare FAI and MVC admissions in the ED. Methods: A retrospective cross-sectional review of all admissions resulting from FAI and MVC from May, 2009 to December, 2012. The trends in rate of admissions per month and yearly was assessed and compared. Analysis was done using Stata 11.0 Results: There were 409 FAI and 11,195 MVC admissions over years. Men were more involved in both MVC and FAI than women. FAI and MVC admissions occurred mostly between June and August, and November and December each year. FAI admissions have increased by seven-fold in four years whereas MVC admissions increased by 1.8 in 2011 and declined by 11.5% by the end of 2012. In 2009, FAI constituted 0.8% of all injuries in the ED in 2009 and at the end of 2012 contributed 5% to the injury pool. Conclusion: MVC continue to be a major cause of injury admissions, however the rising FAI admissions cannot be overlooked. FAI may have gained public health significance in Ghana and requires attention as MVC

Perception of Komfo Anokye Teaching Hospital Emergency Centre staff on acuity of patients” presentation and appropriateness of attendance

Emergency Centre (EC) overcrowding influences patient outcomes, use of resources, staff morale, and patient satisfaction. Inappropriate attenders contribute to overcrowding in the EC. Patel found that 24.5% of patients who present to EC do not require emergency care in Canada. The EC of Komfo Anokye Teaching Hospital has overcrowding challenges and health workers’ perception of causes of overcrowding may inform their approach to care of emergency patients. The aim was to describe EC staff perception of acuity of presentation and appropriateness of attendance of emergency patients. Methods: 95 EC staff comprising 34 physicians and 61 nurses were asked to complete a structured questionnaire to assess perceptions of appropriateness of patients presenting to the EC. Staff sampled could participate in the study if they had previously worked or were currently working in the EC. Answers given on the questionnaire were analysed using STATA 11.0. Results: 55.8% of staff thought that walk-in patients attended the EC more frequently than referred patients. 50.5% of staff thought that referred patients often presented with acute conditions and a similar number (49.5%) thought that for walk-in patients. 67% of staff had turned patients away from the EC when they felt their attendance was inappropriate. Of these, 84.2% had turned away more walk-in patients than referred patients. 66.2% of staff thought that referred patients, though often appropriate attenders were frequently triaged to lower than expected acuity category. Discussion: Staff in this study were not unanimous on the acuity of presentation of walk-in patients and referred patients. Walk-in patients were more likely turned away from the EC. Though perception of staff may hold inherent weakness of objectiveness, this may inform staff attitudes to care for walk-in patients. Negative perceptions of staff on overcrowding in EC could be addressed through staff training and policy directed at reducing EC overcrowding

The use of open source electronic medical records in an urban ED in Kumasi-Ghana

In a busy emergency department (ED), missing patient medical records is a common complaint to contend with. Electronic medical records (EMR) may be one useful way of ensuring patient record integrity and confidentiality. KATH ED sees 28,000 patients a year and integrity of patient records is a major challenge. This study sought to improve the integrity of medical records within the ED and efficiency of patient flow within the ED Methods: Regular panel meetings of emergency physicians, IT specialists and biostatisticians were held from February, 2012 to February, 2013. Open source software, Openemr was adapted in the creation of electronic medical records for the ED of KATH in February, 2012. Changes were made to the software included registration and patient search, triage board, doctor’s notes whiteboard to reflect the pattern of practice in KATH ED. Results: The EMR allows registration, triage and the entire medical records to be stored on patients. 12,000 Patient demographics have been migrated on to the EMR. Emergency physicians and charge nurses are able to monitor patient flow in the ED. Conclusion: Open source medical records may be the most appropriate and cost-effective software to adapt for keeping patient records electronically in a low resource setting. Further studies need to be conducted to demonstrate how EMR may affect the pace of work in the ED