The implementation of the South African Triage Score (SATS) in an urban teaching hospital, Ghana

IntroductionTriage is the process of sorting patients based on the level of acuity to ensure the most severely injured and ill patients receive timely care before their condition worsens. The South African Triage Scale (SATS) was developed out of a need for an accurate and objective measure of urgency based on physiological parameters and clinical discriminators that is easily implemented in low resource settings. SATS was introduced in the emergency center (EC) of Komfo Anokye Teaching Hospital (KATH) in January 2010. This study seeks to evaluate the accurate use of the SATS by nurses at KATH.MethodsThis cross-sectional study was conducted in the EC at KATH in Kumasi, Ghana. Patients 12years and over with complete triage information were included in this study. Each component of SATS was calculated (i.e. for heart rate of 41–50, a score of 1 was given) and summed. This score was compared to the original triage score. When scores did not equate, the entire triage record was reviewed by an emergency physician and an advanced practice emergency nurse separately to determine if the triage was appropriate. These reviews were compared and consensus reached.Results52 of 903 adult patients (5.8%) were judged to have been mis-triaged by expert review; 49 under-triaged (sent to a zone that corresponded to a lower acuity level than they should have been, based on their vital signs) and 3 over-triaged. Of the 49 patients who were under-triaged, 34 were under-triaged by one category and 7 by two categories.ConclusionUnder-triage is a concern to patient care and safety, and while the under-triage rate of 5.7% in this sample falls within the 5–10% range considered unavoidable by the American College of Surgeons Committee on Trauma, concentrated efforts to regularly train triage nurses to ensure no patients are under-triaged have been undertaken. Overall though, SATS has been implemented successfully in the EC at KATH by triage nurses

Funding global emergency medicine research-from seed grants to NIH support

BACKGROUND: Funding for global health has grown significantly over the past two decades. Numerous funding opportunities for international development and research work exist; however, they can be difficult to navigate. The 2013 Academic Emergency Medicine consensus conference on global health and emergency care identified the need to strengthen global emergency care research funding, solidify existing funding streams, and expand funding sources. RESULTS: This piece focuses on the various federal funding opportunities available to support emergency physicians conducting international research from seed funding to large institutional grants. In particular, we focus on the application and review processes for the Fulbright and Fogarty programs, National Institutes of Health (NIH) Career development awards, and the Medical Education Partnership Initiative (MEPI), including tips and pathways through each application process. CONCLUSIONS: Lastly, the paper provides an index that may be used as a guide in determining whether the amount of funding provided by a grant is worth the effort in applying

Cardiopulmonary ultrasound for critically ill adults improves diagnostic accuracy in a resourceâ limited setting: the AFRICA trial

ObjectiveTo assess the effects of a cardiopulmonary ultrasound (CPUS) examination on diagnostic accuracy for critically ill patients in a resourceâ limited setting.MethodsApproximately half of the emergency medicine resident physicians at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, were trained in a CPUS protocol. Adult patients triaged to the resuscitation area of the emergency department (ED) were enrolled if they exhibited signs or symptoms of shock or respiratory distress. Patients were assigned to the intervention group if their treating physician had completed the CPUS training. The physician’s initial diagnostic impression was recorded immediately after the history and physical examination in the control group, and after an added CPUS examination in the intervention group. This was compared to a standardised final diagnosis derived from post hoc chart review of the patient’s care at 24 h by two blinded, independent reviewers using a clearly defined and systematic process. Secondary outcomes were 24â h mortality and use of IV fluids, diuretics, vasopressors and bronchodilators.ResultsOf 890 patients presenting during the study period, 502 were assessed for eligibility, and 180 patients were enrolled. Diagnostic accuracy was higher for patients who received the CPUS examination (71.9% vs. 57.1%, Î 14.8% [CI 0.5%, 28.4%]). This effect was particularly pronounced for patients with a â cardiacâ diagnosis, such as cardiogenic shock, congestive heart failure or acute valvular disease (94.7% vs. 40.0%, Î 54.7% [CI 8.9%, 86.4%]). Secondary outcomes were not different between groups.ConclusionsIn an urban ED in Ghana, a CPUS examination improved the accuracy of the treating physician’s initial diagnostic impression. There were no differences in 24â h mortality and a number of patient care interventions.ObjectifEvaluer les effets de l’examen échographique cardioâ pulmonaire (CPUS) sur la précision du diagnostic chez les patients gravement malades dans un cadre à ressource limitée.MéthodesEnviron la moitié des médecins résidents en médecine d’urgence à la Komfo Anokye Teaching Hôpital (KATH) à Kumasi, au Ghana ont été formés pour un protocole de CPUS. Les patients adultes triés dans l’unité de ressuscitation des soins intensifs ont été inscrits s’ils présentaient des signes ou des symptômes de choc ou d’une détresse respiratoire. Les patients ont été assignés au groupe d’intervention si leur médecin traitant avait suivi la formation CPUS. Le diagnostic initial du médecin a été enregistré immédiatement après l’anamnèse et l’examen physique dans le groupe témoin, et après un examen CPUS ultérieur dans le groupe d’intervention. Cela a été comparé à un diagnostic final standard dérivé de l’analyse postâ hoc en aveugle des dossiers de soins du patient à 24 heures par deux examinateurs indépendants, au moyen d’un processus clairement défini et systématique. Les résultats secondaires étaient la mortalité de 24 heures et l’utilisation de fluides en IV, de diurétiques, de vasopresseurs et de bronchodilatateurs.RésultatsSur 890 patients présentés au cours de la période dâ étude, 502 ont été évalués pour lâ éligibilité et 180 patients ont été inscrits. La précision du diagnostic était plus élevée chez les patients ayant reçu l’examen CPUS (71,9% contre 57,1%, Î 14,8% [IC: 0,5% à 28.4%]). Cet effet était particulièrement marquée pour les patients avec un diagnostic «cardiaque», tel que le choc cardiogénique, l’insuffisance cardiaque congestive ou une maladie aiguë valvulaire (94,7% contre 40,0%, Î 54,7% [IC: 8,9% à 86,4%]). Les résultats secondaires nâ étaient pas différents entre les groupes.ConclusionsDans un service de soins intensifs urbain au Ghana, un examen CPUS améliorait la précision du diagnostic initial du médecin traitant. Il n’y avait aucune différence dans la mortalité de 24 heures et dans le nombre des interventions de soins.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141626/1/tmi12992.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141626/2/tmi12992_am.pd

Advanced Emergency Trauma

In 2009, the University of Michigan Department of Emergency Medicine working with global health partners at Komfo Anokye Teaching Hospital (KATH), Kwame Nkrumah University of Science and Technology (KNUST), Ghana College of Physicians and Surgeons, and the Ghana Ministry of Health established the Ghana Emergency Medicine Collaborative. The overall goal of the collaborative is to improve the provision of emergency care in Ghana through the development of physician, nursing and medical student training programs. This NIH-Fogarty International Center funded project also explores the use of new educational modalities such as open educational resources to provide education in Ghana. ** As part of this project, a 5-day Advanced Emergency Trauma Course (AETC) was constructed utilizing curricular materials from existing U.S. based emergency medicine residencies with modification to the available resources of developing Low-Middle Income Countries (LMICs) such as Ghana. The course, which was designed by University of Michigan and University of Utah Emergency Medicine Faculty includes 20 hours of didactic teaching material in open educational resource format, low-cost simulation models for procedural training and assessment tools. Attached are the full 20 hours of didactic materials in OER format. The full course is available by contacting the course director, Patrick Carter at [email protected]://deepblue.lib.umich.edu/bitstream/2027.42/94133/1/education-med-em-aetc-2009.zi

Ghana Emergency Medicine Collaborative

Current emergency care in Ghana is sub-optimal with significant delays to definitive care and high morbidity and mortality. The Ghanaian government has recently invested in physical infrastructure for emergency care at major teaching hospitals, but the human resources to provide care are inadequate. To address this need, the Ghana Emergency Medicine Collaborative has proposed an innovative training program focused on medical students, nurses, and residents with the formation of a new faculty for sustainable training. This program will train emergency medicine personnel in injury and acute medical illness management, expose trainees to research methodology, administrative and leadership aspects of emergency medicine. This program receives funding from the Medical Education Partnership Initiative (MEPI).http://deepblue.lib.umich.edu/bitstream/2027.42/94134/1/education-med-em-gemc.zi

Ambulance or taxi? High acuity prehospital transports in the Ashanti region of Ghana

African emergency medical services (EMS) systems are inadequate, thereby necessitating its selective use. This study aims to investigate differences in mode of arrival to the Emergency Centre (EC) at Komfo Anokye Teaching Hospital in Kumasi, Ghana by acuity, injury and referral status. Methods: A cross-sectional survey was conducted in the EC at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, in 2011. A survey was administered to all patients triaged to the EC. Patients were excluded if they were under 18 years of age, unable to communicate in English, Twi, or Fante, had altered mental status, or were deceased. Data were inputted into an excel spread sheet and uploaded to SPSS. Descriptive statistics were computed. Inferential statistics were performed testing for differences and associations between modes of arrival and acuity level, referral and injury status. Results: Of the 1004 patients enrolled, 411 (41%) had an injury-related complaint, and 458 (45.6%) were inter-facility transfers (“referrals”). 148 (14.8%) arrived by ambulance, and 778 (77.6%) non-ambulance (38% private cars, 38% taxis). 67 (6.7%) were triaged as Red, 276 (27.5%) as Orange, and 637 (63.4%) as Yellow (highest to lowest acuity). Ambulance arrival was positively associated with a higher triage score (OR: 1.53). Patients referred from other facilities were almost twice as likely (OR 1.92) to arrive at the KATH EC via ambulance than those not referred. Patients with injuries and higher acuities patients were more likely to be transported to KATH by ambulance (OR 1.86 and 1.87 respectively). All results are highly statistically significant. Conclusion: Although a minority of patients were transported by ambulance, they represented the most acute patients arriving at the KATH EC. Given the limited availability of EMS resources and ambulances in Ashanti, selective ambulance use appears warranted and should inform prehospital care planning

Funding Global Emergency Medicine Research—From Seed Grants To Nih Support

Background: Funding for global health has grown significantly over the past two decades. Numerous funding opportunities for international development and research work exist; however, they can be difficult to navigate. The 2013 Academic Emergency Medicine consensus conference on global health and emergency care identified the need to strengthen global emergency care research funding, solidify existing funding streams, and expand funding sources. Results: This piece focuses on the various federal funding opportunities available to support emergency physicians conducting international research from seed funding to large institutional grants. In particular, we focus on the application and review processes for the Fulbright and Fogarty programs, National Institutes of Health (NIH) Career development awards, and the Medical Education Partnership Initiative (MEPI), including tips and pathways through each application process. Conclusions: Lastly, the paper provides an index that may be used as a guide in determining whether the amount of funding provided by a grant is worth the effort in applying

The evolution and current state of emergency care in Ghana

Emergency Medicine as a specialty has only recently been introduced to Ghana. This article reviews the overall health and medical care systems as well as the evolution and the current state of emergency care in Ghana and the progress made in establishing Emergency Medicine (EM) as a specialty along the Anglo-American model of emergency care. The article also describes the improvements implemented in emergency patient care, and emergency medicine management systems. Although there are challenges to overcome, much optimism remains about the future of this new specialty in Ghana and its ability to transform the face of emergency care

Skills and educational needs of accident and emergency nurses in Ghana: An initial needs analysis

Background: The specialty of emergency medicine is highly reliant on a well-trained team of providers. Ghana has recently begun a specialist training program for physicians and the need to train specialist emergency nurses has been recognized. The first step to developing this training is to conduct a needs assessment. This study was conducted to elucidate current nursing functioning and gain knowledge of the educational desires and needs for nurses in the Accident and Emergency Center (A&E) at Komfo Anokye Teaching Hospital (KATH). Methods: Three nurses from the University of Michigan (UM) worked collaboratively with the nursing leadership at KATH to conduct a needs assessment of currently practising nurses in the A&E. The UM nurses observed nursing practice in the department and KATH nurses participated in a multiple choice exam, a self-assessment questionnaire of educational desires, answered written open-ended questions and participated in focus groups. Results: KATH nurses scored relatively low on a general knowledge multiple choice exam, and indicated through the self-assessment that they would like to learn more about many topics. Open-ended questions gave further insight into areas of knowledge gaps. Several themes including Cohesion, Carrying out Orders/Decision Making and Overwhelming Volume, emerged from observations in the emergency department. Discussion: Current nurse knowledge and function as well as areas to focus on for future specialty training in emergency nursing have been identified by this needs assessment. The emergency department nurses shared an overwhelming interest in increasing their skill level, learning new methods of patient care and implementing new technologies into their clinical practice