Skip to main content
Top
Published in: World Journal of Surgery 9/2017

01-09-2017 | Original Scientific Report

Management and Outcomes of Acute Surgical Patients at a District Hospital in Uganda with Non-physician Emergency Clinicians

Authors: Caleb Dresser, Usha Periyanayagam, Brad Dreifuss, Robert Wangoda, Julius Luyimbaazi, Mark Bisanzo, On behalf of the Global Emergency Care Collaborative Investigators

Published in: World Journal of Surgery | Issue 9/2017

Login to get access

Abstract

Introduction

Acute surgical care services in rural Sub-Saharan Africa suffer from human resource and systemic constraints. Developing emergency care systems and task sharing aspects of acute surgical care addresses many of these issues. This paper investigates the degree to which specialized non-physicians practicing in a dedicated Emergency Department contribute to the effective and efficient management of acute surgical patients.

Methods

This is a retrospective review of an electronic quality assurance database of patients presenting to an Emergency Department in rural Uganda staffed by non-physician clinicians trained in emergency care. Relevant de-identified clinical data on patients admitted directly to the operating theater from 2011 to 2014 were analyzed in Microsoft Excel.

Results

Overall, 112 Emergency Department patients were included in the analysis and 96% received some form of laboratory testing, imaging, medication, or procedure in the ED, prior to surgery. 72% of surgical patients referred by ED received preoperative antibiotics, and preoperative fluid resuscitation was initiated in 65%. Disposition to operating theater was accomplished within 3 h of presentation for 73% of patients. 79% were successfully followed up to assess outcomes at 72 h. 92% of those with successful follow-up reported improvement in their clinical condition. The confirmed mortality rate was 5%.

Conclusion

Specialized non-physician clinicians practicing in a dedicated Emergency Department can perform resuscitation, bedside imaging and laboratory studies to aid in diagnosis of acute surgical patients and arrange transfer to an operating theater in an efficient fashion. This model has the potential to sustainably address structural and human resources problems inherent to Sub-Saharan Africa’s current acute surgical care model and will benefit from further study and expansion.
Literature
3.
go back to reference Luboga S, Macfarlane SB, von Schreeb J, Kruk ME, Cherian MN et al (2009) Increasing access to surgical services in Sub-Saharan Africa: priorities for national and International Agencies recommended by the Bellagio Essential Surgery Group. PLoS Med 6(12):e1000200CrossRefPubMedPubMedCentral Luboga S, Macfarlane SB, von Schreeb J, Kruk ME, Cherian MN et al (2009) Increasing access to surgical services in Sub-Saharan Africa: priorities for national and International Agencies recommended by the Bellagio Essential Surgery Group. PLoS Med 6(12):e1000200CrossRefPubMedPubMedCentral
6.
go back to reference Natunlya V, Reich M (2002) The neglected epidemic: road traffic injuries in developing countries. BMJ 324:1139–1141CrossRef Natunlya V, Reich M (2002) The neglected epidemic: road traffic injuries in developing countries. BMJ 324:1139–1141CrossRef
7.
go back to reference Hyder A, Peden M (2003) Inequality and road-traffic injuries: call for action. The Lancet 362:2034–2035CrossRef Hyder A, Peden M (2003) Inequality and road-traffic injuries: call for action. The Lancet 362:2034–2035CrossRef
8.
go back to reference World Health Organization Facilitators Report (2005) Joint WHO meetings with ministry of health on Buruli ulcer control program and strengthening emergency and essential surgical training in Ghana’s Greater Accra and Ashanti regions. 15–20 Aug 2005 World Health Organization Facilitators Report (2005) Joint WHO meetings with ministry of health on Buruli ulcer control program and strengthening emergency and essential surgical training in Ghana’s Greater Accra and Ashanti regions. 15–20 Aug 2005
12.
13.
go back to reference Ike-Okoye O (2006) Ophthalmic theatre time utilization in a Nigerian teaching hospital. Niger J Med 15:285–287PubMed Ike-Okoye O (2006) Ophthalmic theatre time utilization in a Nigerian teaching hospital. Niger J Med 15:285–287PubMed
14.
go back to reference Ifesanya A, Ogundele O, Ifesanya J (2013) Orthopaedic surgical treatment delays at a tertiary hospital in sub Saharan Africa: communication gaps and implications for clinical outcomes. Niger Med J 54(6):420–425CrossRefPubMedPubMedCentral Ifesanya A, Ogundele O, Ifesanya J (2013) Orthopaedic surgical treatment delays at a tertiary hospital in sub Saharan Africa: communication gaps and implications for clinical outcomes. Niger Med J 54(6):420–425CrossRefPubMedPubMedCentral
15.
go back to reference Aderounmu AO, Adeoti ML, Oguntola AS et al (2006) Pattern and outcome of emergency surgery in a new Nigerian Teaching Hospital: the LAUTECH Osogbo experience. Niger Postgrad Med J 13:172–175PubMed Aderounmu AO, Adeoti ML, Oguntola AS et al (2006) Pattern and outcome of emergency surgery in a new Nigerian Teaching Hospital: the LAUTECH Osogbo experience. Niger Postgrad Med J 13:172–175PubMed
16.
go back to reference Adamu A, Maigatari M, Lawal K, Iliyasu M (2010) Waiting time for emergency abdominal surgery in Zaria, Nigeria. Afr Health Sci 10(1):46–53PubMedPubMedCentral Adamu A, Maigatari M, Lawal K, Iliyasu M (2010) Waiting time for emergency abdominal surgery in Zaria, Nigeria. Afr Health Sci 10(1):46–53PubMedPubMedCentral
17.
go back to reference Nega B (2009) Pattern of acute abdomen and variables associated with adverse outcome in a rural primary hospital setting. Ethiop Med J 47(2):143–151PubMed Nega B (2009) Pattern of acute abdomen and variables associated with adverse outcome in a rural primary hospital setting. Ethiop Med J 47(2):143–151PubMed
18.
go back to reference Spiegel D, Gosselin R (2007) Surgical services in low-income and middle-income countries. Lancet 370:1013–1015CrossRefPubMed Spiegel D, Gosselin R (2007) Surgical services in low-income and middle-income countries. Lancet 370:1013–1015CrossRefPubMed
19.
go back to reference Ozgediz D, Kijjambu S, Galukande M, Dubowitz G, Mabweijano J, Mijumbi C, Cherian M, Kaggwa S, Luboga S (2008) Africa’s neglected surgical workforce crisis. The Lancet 371:627–628CrossRef Ozgediz D, Kijjambu S, Galukande M, Dubowitz G, Mabweijano J, Mijumbi C, Cherian M, Kaggwa S, Luboga S (2008) Africa’s neglected surgical workforce crisis. The Lancet 371:627–628CrossRef
21.
go back to reference Hsia R, Mbembati N, Macfarlane S, Kruk M (2012) Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap. Health Policy Plan 27(3):234–244CrossRefPubMed Hsia R, Mbembati N, Macfarlane S, Kruk M (2012) Access to emergency and surgical care in sub-Saharan Africa: the infrastructure gap. Health Policy Plan 27(3):234–244CrossRefPubMed
22.
go back to reference Rominski S, Bell S, Oduro G, Ampong P, Oteng R, Donkor P (2014) The implementation of the South African Triage Score (SATS) in an urban teaching hospital, Ghana. Afr J Emerg Med 4:71s–75sCrossRef Rominski S, Bell S, Oduro G, Ampong P, Oteng R, Donkor P (2014) The implementation of the South African Triage Score (SATS) in an urban teaching hospital, Ghana. Afr J Emerg Med 4:71s–75sCrossRef
24.
go back to reference Beard J, Oresanya L, Akoko L, Mwanga A, Mkony C, Dicker R (2014) Surgical task-shifting in a low-resource setting: outcomes after major surgery performed by nonphysician clinicians in Tanzania. World J Surg 38:1398–1404. doi:10.1007/s00268-013-2446-2 CrossRefPubMed Beard J, Oresanya L, Akoko L, Mwanga A, Mkony C, Dicker R (2014) Surgical task-shifting in a low-resource setting: outcomes after major surgery performed by nonphysician clinicians in Tanzania. World J Surg 38:1398–1404. doi:10.​1007/​s00268-013-2446-2 CrossRefPubMed
25.
go back to reference Tyson A, Msiska N, Kiser M, Samuel J, Mclean S, Varelaa C, Charles A (2014) Delivery of operative pediatric surgical care by physicians and non-physician clinicians in Malawi. Int J Surg 12:509–515CrossRefPubMedPubMedCentral Tyson A, Msiska N, Kiser M, Samuel J, Mclean S, Varelaa C, Charles A (2014) Delivery of operative pediatric surgical care by physicians and non-physician clinicians in Malawi. Int J Surg 12:509–515CrossRefPubMedPubMedCentral
26.
go back to reference Ong M, Guang TY, Yang TK (2015) Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: a single center experience. World J Gastrointest Surg 7(9):208–213CrossRefPubMedPubMedCentral Ong M, Guang TY, Yang TK (2015) Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: a single center experience. World J Gastrointest Surg 7(9):208–213CrossRefPubMedPubMedCentral
27.
go back to reference Hampton D, Fabricant J, Differding J, PROMMTT Study Group et al (2013) Prehospital intravenous fluid is associated with increased survival in trauma patients. J Trauma Acute Care Surg 75(Suppl 1):S9–S15CrossRefPubMedPubMedCentral Hampton D, Fabricant J, Differding J, PROMMTT Study Group et al (2013) Prehospital intravenous fluid is associated with increased survival in trauma patients. J Trauma Acute Care Surg 75(Suppl 1):S9–S15CrossRefPubMedPubMedCentral
28.
go back to reference Akinbami F, Askari R, Steinberg J, Panizales M, Rogers S (2011) Factors affecting morbidity in emergency general surgery. Am J Surg 201(4):456–462CrossRefPubMed Akinbami F, Askari R, Steinberg J, Panizales M, Rogers S (2011) Factors affecting morbidity in emergency general surgery. Am J Surg 201(4):456–462CrossRefPubMed
29.
go back to reference Teri A, Reynolds T, Mfinanga J, Sawe H, Runyon M, Mwafongoa V (2012) Emergency care capacity in Africa: a clinical and educational initiative in Tanzania. J Public Health Policy 33(S1):S126–S137CrossRef Teri A, Reynolds T, Mfinanga J, Sawe H, Runyon M, Mwafongoa V (2012) Emergency care capacity in Africa: a clinical and educational initiative in Tanzania. J Public Health Policy 33(S1):S126–S137CrossRef
30.
go back to reference Frank D, Dunleavy K, Nambaziira R et al (2014) Upper extremity injury management by non-physician emergency practitioners in rural Uganda: a pilot study. Afr J Emerg Med 4:25–30CrossRef Frank D, Dunleavy K, Nambaziira R et al (2014) Upper extremity injury management by non-physician emergency practitioners in rural Uganda: a pilot study. Afr J Emerg Med 4:25–30CrossRef
31.
go back to reference Hammerstedt H, Maling S, Kasyaba R et al (2014) Addressing WHO resolution 60.22: a pilot project to create access to acute care services in Uganda. Ann Emerg Med 64:1–8CrossRef Hammerstedt H, Maling S, Kasyaba R et al (2014) Addressing WHO resolution 60.22: a pilot project to create access to acute care services in Uganda. Ann Emerg Med 64:1–8CrossRef
32.
go back to reference Bisanzo M, Nichols K, Hammerstedt H et al (2012) Nurse-administered ketamine sedation in an emergency department in rural Uganda. Ann Emerg Med 59:268–275CrossRefPubMed Bisanzo M, Nichols K, Hammerstedt H et al (2012) Nurse-administered ketamine sedation in an emergency department in rural Uganda. Ann Emerg Med 59:268–275CrossRefPubMed
33.
go back to reference Periyanayagam U, Dreifuss B, Hammerstedt H et al (2012) Acute care needs in a rural sub-Saharan Africa emergency center: a retrospective analysis. African J Emerg Med 2:151–158CrossRef Periyanayagam U, Dreifuss B, Hammerstedt H et al (2012) Acute care needs in a rural sub-Saharan Africa emergency center: a retrospective analysis. African J Emerg Med 2:151–158CrossRef
34.
go back to reference Khoshbin A, So J, Aleem I, Stephens D, Matlow A, Wright J, SickKids Surgical Site Infection Task Force (2015) Antibiotic prophylaxis to prevent surgical site infections in children: a Prospective Cohort Study. Ann Surg 262(2):397–402CrossRefPubMed Khoshbin A, So J, Aleem I, Stephens D, Matlow A, Wright J, SickKids Surgical Site Infection Task Force (2015) Antibiotic prophylaxis to prevent surgical site infections in children: a Prospective Cohort Study. Ann Surg 262(2):397–402CrossRefPubMed
35.
go back to reference Smith B, Fox N, Fakhro A, LaChant M, Pathak A, Ross S, Seamon MJ (2012) “SCIP”ping antibiotic prophylaxis guidelines in trauma: the consequences of noncompliance. J Trauma Acute Care Surg 73(2):452–456CrossRefPubMed Smith B, Fox N, Fakhro A, LaChant M, Pathak A, Ross S, Seamon MJ (2012) “SCIP”ping antibiotic prophylaxis guidelines in trauma: the consequences of noncompliance. J Trauma Acute Care Surg 73(2):452–456CrossRefPubMed
36.
go back to reference Chukuezi A, Nwosu J (2010) Mortality pattern in the surgical wards: a five year review at Federal Medical Center, Owerri, Nigeria. Int J Surg 8:381–383CrossRefPubMed Chukuezi A, Nwosu J (2010) Mortality pattern in the surgical wards: a five year review at Federal Medical Center, Owerri, Nigeria. Int J Surg 8:381–383CrossRefPubMed
37.
go back to reference Ng-Kamstra JS, Greenberg SLM, Kotagal M et al (2015) Use and definitions of perioperative mortality rates in low-income and middle-income countries: a systematic review. Lancet 385((The Lancet Commission on Global Surgery Abstracts Special Issue)):S29CrossRefPubMed Ng-Kamstra JS, Greenberg SLM, Kotagal M et al (2015) Use and definitions of perioperative mortality rates in low-income and middle-income countries: a systematic review. Lancet 385((The Lancet Commission on Global Surgery Abstracts Special Issue)):S29CrossRefPubMed
Metadata
Title
Management and Outcomes of Acute Surgical Patients at a District Hospital in Uganda with Non-physician Emergency Clinicians
Authors
Caleb Dresser
Usha Periyanayagam
Brad Dreifuss
Robert Wangoda
Julius Luyimbaazi
Mark Bisanzo
On behalf of the Global Emergency Care Collaborative Investigators
Publication date
01-09-2017
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 9/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-017-4014-7

Other articles of this Issue 9/2017

World Journal of Surgery 9/2017 Go to the issue