Availability and Readiness of Hospitals for Emergency Trauma Care Delivery: A Case Study of Nsawam Government Hospital

Abstract

Background : Globally, injuries and violence are issues of public health concern with burden disproportionately borne by Lower/Lower-Middle Income Countries. Public health strategies to mitigate this problem border on injury prevention and the provision of efficient emergency trauma care and surgical systems. Ghana has a high burden of trauma, however trauma care systems are not as organized as the standards required. District hospitals are the main providers equipped to provide emergency trauma care at the primary level. Objective: This study was therefore conducted to assess the availability and readiness of the hospitals for trauma emergency care services comprising of emergency room, surgical, and blood transfusion services, with a case study of Nsawam Government Hospital. Methods: A cross-sectional descriptive design was used with structured questionnaires adapted from World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) tool and the WHO’s Guidelines for Essential Trauma Care. The checklists were administered to 36 staff members of the Emergency Department of the hospital, and then 8 purposively selected administrative staff of other units that provided services to trauma patients. Simple descriptive analysis was done. The availability ratings of physical resources needed in the Accident and Emergency Unit were analysed by generating median values from a four-point Likert scale (from 0-3). The factors influencing resources availability were analysed using frequencies and percentages of responses while the readiness scores of the hospital for emergency trauma surgical care were analysed using the mean availability of all items needed for a specific service, expressed as a percentage. Results: Forty-four respondents were interviewed: Nine were involved in managerial roles, with remainder being different cadre of Emergency room staff (13 Physician Assistants, 16 General Nurses and 6 Medical Officers). Nsawam Government Hospital offered both emergency room services, minor and major trauma surgeries as well as blood transfusion services. Circulatory medicines , general surgery and basic airway equipment had the highest median availability rates of 3 (adequate) each. In the Emergency room, essential low-cost equipment for advanced airway had median rating of 0 (absent) while neurosurgical care , chest tubes with underwater seal and electronic cardiac monitors had median availability ratings of 1 (inadequate) each. The readiness score for hospital emergency room services was 71% while that for minor and major trauma surgery was 90% and 95% respectively. Blood transfusion and basic amenities had readiness scores of 87.5% and 85.7% respectively. These least readiness score obtained in the emergency room was influenced by low scores for tracer indicators for advanced imaging and advanced airway in the Emergency Unit. Factors contributing to low availability of equipment were associated with the absence of the equipment, staffing, stock-outs, user-fees and equipment breakdown. Conclusion: This study concludes that the availability of trauma emergency care in Nsawam Government Hospital was high, and the readiness scores of the hospital for surgery and blood transfusion was higher compared to Emergency Room services. Unreliable availability of advanced airway devices and advanced imaging contributed to lower readiness for Emergency Room services. Hence, managerial strategies to improve the availability of essential low-cost items in the Emergency Department and to strengthen the referral system are recommended