194EMF Forging a Locally Driven Public Sector Emergency Care Research Network in Ethiopia

Abstract

Ethiopia faces increasing demand for coordinated emergency care services, but lack of systematic data regarding emergency disease burden and care limits system planning and resource allocation. We aimed to establish Ethiopia’s first comprehensive emergency care research network in Addis Ababa, and show feasibility through collation of a six-month citywide emergency care patient database. Following local ethical approval from the network coordinating center, St. Paul’s Hospital Millennium Medical College, Chief Executive Officers or Medical Directors from each of all ten government general hospitals in Addis Ababa, Ethiopia, were invited to participate. At participating hospitals, we located all emergency department, admissions office, and inpatient ward logbooks corresponding to patient visits from 8/1/2014 to 2/1/2015 (six months). Relevant logbook data were photographed, and are being entered electronically by trained professional health care transcriptionists, audited to ensure a low rate of data entry error, and standardized through data cleaning to facilitate aggregation for system-wide analysis. All hospital executives expressed strong enthusiasm in sharing institutional emergency care and inpatient data for the purpose of local system-wide research and health sector planning. In total, 188 logbooks were obtained from all ten institutions, corresponding to 6838 pages photographed for the study period. Data transcription, auditing, and cleaning are underway. Several unanticipated delays were encountered in the coordination and execution of database assembly. Study efforts have garnered gratifying interest from leadership in the Ethiopian Federal Ministry of Health (FMOH). Among local health care executives in Ethiopia, we found strong and unanimous openness to collaboration for system-wide research. Local project leadership and early backing from the FMOH were both essential in establishing institutional trust and network support. Compared to individual patient records, which can be prohibitively difficult to identify and abstract, hospital logbooks may provide a more accessible source of patient data for institutions in lower-income settings lacking electronic health record systems. Routine logbook data abstraction initially appears feasible across a health system, though is not without significant operational challenges. Further research is needed to determine long-term cost-effectiveness of analysis using paper-based hospital logbooks versus an electronic health record system.