Quality Of Medical Care At The Emergency Departments Of Bungoma County Public Hospitals, Kenya

ABSTRACT

Quality medical care at emergency departments(EDs) is an international mandate. In Kenya the services are mainly offered in the outpatient departments whose quality of care has not been evaluated. This study investigated quality of care at EDs of public hospital in Bungoma County by evaluating availability of infrastructure, equipment, supplies and personnel. The study assessed processes, protocols and outcomes of care at the EDs. A cross-sectional study design was employed, with a sample of 10 ED in-charges and 398 patients. The participants were proportionately recruited from the EDs via probability proportional to size(PPS). Quality was assessed using the Donabedian model with structure assessed by evaluating availability of infrastructure, equipment, supplies and personnel for emergency care. Process was evaluated by measuring turnaround timelines, assessment of presence and utilization of triage systems, protocols and guidelines. Outcomes were measured using number of admissions, deaths, left without being seen, unplanned re-attendance, and patient service experience. Data were collected using WHO observation checklists and questionnaires then analyzed using descriptive and inferential statistics. Infrastructure availability was 42.0% with all EDs lacking resuscitation rooms and high dependency units. Imaging rooms were in 40% of the hospitals, blood banks in 50%, and running water in 70%. Equipment availability was 34.7% with oxygen source, pulse oximeter, point of care ultrasound and trauma cart being available in 10%. Regular maintenance of equipment was in 52.5% of the EDs. Availability of supplies for resuscitation was 52% with Supplies for airway management being the least (22%). Mean personnel availability was 47.5%, with doctors being the least available: only 2 hospitals had physicians and general surgeons. None of the hospitals had a triage system nor performed 12 lead EKG. The mean patient service experience was 76.1 %, with 49.5% rating overall care as good. 6.1% of patients were admitted, 0.9% left without being seen, 35.7% were unplanned re-attendants, 0.1% died. The mean time to clinician was 29.44 minutes, mean time to treatment was 99.5 minutes; mean total time at ED was 111.6 minutes. In conclusion the study showed that quality of care at the EDs in Bungoma County was affected by lack of adequate infrastructure, trained personnel, equipment, supplies and processes such of triage systems. This has contributed to prolonged turnaround time and high re-attendance rates. There is need for provision of adequate infrastructure, equipment, personnel and systems for emergency care in public hospitals EDs in Bungoma County to improve quality of care.