Emergency Center Care Research Articles

Characterising emergency centre encounters in Mbour, Senegal as emergent-emergency care, emergent-primary care or non-emergent.

IntroductionEmergency medicine is a relatively new specialty in Africa, with the first emergency medicine training programme only started in South Africa in 2004. Continued emergency centre development and preparedness relies on a better understanding of the quantity and category of emergency centre encounters within the various African regions.MethodsThis study was conducted over four, consecutive months in 2014 using a retrospective chart review, aimed to examine the types of visits made to one emergency centre at the Grande Mbour Hospital in Mbour, Senegal. The New York University Emergency Department Algorithm was used to classify emergency centre encounters. Each diagnosis included in this study was classified per the algorithm as non-emergent; emergent but primary care treatable; emergent with emergency centre care needed but avoidable/preventable; and emergent with emergency centre care needed and not avoidable/preventable. The algorithm also categorised diagnoses of injury, mental health problems, alcohol, or substance abuse.ResultsThis study included 1268 diagnoses from the emergency centre. The most common presentations in Mbour, Senegal were injuries, with 302 cases (33%), and from the category: emergent but primary care treatable, with 303 cases (33%). In total, 174 cases (19%) were classified as: non-emergent. While only 93 cases (10%) were considered: emergency care needed/preventable or avoidable, a substantial number (n = 218, 24%) were categorised as: emergent with emergency centre care needed and not avoidable/preventable.ConclusionThis study provides the first description of patients presenting for care in the emergency centre of Mbour’s hospital and demonstrates the wide range of illnesses and types of trauma that the emergency centre must accommodate while contending with the limited resources available in the area. Understanding the burden of disease will help prioritise resources appropriately.

Emergency Centre care for sexual assault victims

Sexual assault is a topic of importance worldwide to health professionals that provide emergency care. Victims of sexual assault include adult men, adult women, and children. The prevalence of sexual assault is likely under-reported. These patients should be offered comprehensive medical care upon arrival to the emergency centre. This includes assessment for acute injuries; medical history; physical examination; and possible collection of evidence. Depending on the patient's situation, he or she may be offered prophylactic and therapeutic management, which includes pregnancy testing and emergency contraception, prophylaxis for sexually transmitted infections, and HIV post-exposure prophylaxis. This article addresses the most up-to-date information on this management. Patients should also be offered mental health counselling on-site if appropriate health professionals are available. A number of countries have national protocols for care of the sexual assault patient. Implementing these protocols can be strengthened through such interventions as hiring sexual assault nurse examiners or creating a sexual assault centre within the emergency centre. The patient's immediate and future safety and emotional needs should be evaluated and a plan formulated for safety when the patient is discharged. Medical follow up is recommended and should be strongly encouraged. L'agression sexuelle est un sujet important à l’échelle mondiale pour les professionnels de la santé administrant des soins d'urgence. Les victimes d'agressions sexuelles incluent des hommes adultes, des femmes adultes et des enfants. La fréquence des agressions sexuelles est probablement insuffisamment signalée. Ces patients devraient bénéficier de soins médicaux complets à leur arrivée au service des urgences. Cette prise en charge inclut une évaluation des blessures graves, des antécédents médicaux, un examen physique et une éventuelle collecte de preuves. Selon la situation du patient, ce dernier doit se voir proposer une prise en charge prophylactique et thérapeutique, incluant un test de grossesse et une contraception d'urgence, une prophylaxie contre les infections sexuellement transmissibles, et une prophylaxie post-exposition au VIH. Cet article traite des toutes dernières informations relatives à cette prise en charge. Les patients doivent également se voir proposer une assistance socio-psychologique en santé mentale si des professionnels de la santé appropriés sont disponibles. Certains pays disposent de protocoles nationaux en matière de prise en charge d'un patient victime d'une agression sexuelle. La mise en œuvre de ces protocoles peut être renforcée par le biais d'interventions telles que le recrutement de personnel infirmier examinateur des victimes d'agression sexuelle ou la création d'un centre spécialisé dans les agressions sexuelles au sein du service des urgences. La sécurité immédiate et future du patient et ses besoins émotionnels doivent être évalués et un plan élaboré afin de garantir la sécurité du patient à sa sortie. Un suivi médical est recommandé et vivement encouragé.

The 11P’s of an Afrocentric trauma system for South Africa – time for action!

A trauma system involves the interaction of prehospital care, emergency centre care and definitive care (including prevention and rehabilitation services), providing an organised approach to acutely injured patients within a defined geographical area, from primary care to advanced care. Trauma is, after infectious disease, the second leading cause of death and disability in Africa, and must therefore feature on the national health agendas of all African countries. The requirements for developing cost-efficient, patient-centred trauma systems relevant to South Africa are outlined (each item commencing with a P, and hence the title).

Healthcare utilization and expenditures for low income children with sickle cell disease

While multiple studies have examined the healthcare burden of sickle cell disease (SCD) in adults, few have specifically focused on healthcare utilization and expenditures in children. The objective of this study was to characterize the healthcare utilization and costs associated with the care of low-income children with SCD in comparison to other children of similar socioeconomic status. For the study period, 2004-2007, we conducted a retrospective, cross-sectional descriptive analysis of administrative claims data from a managed care plan exclusively serving low-income children with Medicaid and the State Children's Health Insurance Plan (SCHIP). Patient demographics, continuity of insurance coverage, healthcare utilization, and expenditures were collected for all children enrolled with SCD and the general population within the health plan for comparison. On average, 27% of members with SCD required inpatient hospitalization and 39% utilized emergency care in a given calendar year. Both values were significantly higher than those of the general health plan population (P < 0.0001). Across the study period, 63% of members with SCD averaged one well child check per year and 10% had a minimum of one outpatient visit per year to a hematologist for comprehensive specialty care. Low-income children with SCD demonstrate significantly higher healthcare utilization for inpatient care, emergency center care, and home health care compared to children with similar socio-demographic characteristics. A substantial proportion of children with SCD may fail to meet minimum guidelines for outpatient primary and hematology comprehensive care.