Jurnal Internasional Afrika vol.10 issue.3 2020
African Journal of Emergency Medicine
Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti
Dublin Core
Title
Jurnal Internasional Afrika vol.10 issue.3 2020
African Journal of Emergency Medicine
Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti
African Journal of Emergency Medicine
Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti
Subject
Emergency medicine
Emergency department
Observation unit
Haiti
Stroke
Emergency department
Observation unit
Haiti
Stroke
Description
Introduction: In many low-income countries, Emergency Medicine is underdeveloped and faces many opera-
tional challenges including emergency department (ED) overcrowding and prolonged patient length of stays
(LOS). In high-resource settings, protocolized ED observation unit (EDOU) care reduces LOS while preserving
care quality. EDOUs are untested in low-income countries. We evaluate the effect protocolized EDOU care for
ischemic stroke on the quality and efficiency of care in Haiti.
Methods: We performed a prospective cohort study of protocolized observation care for ischemic stroke at a
Haitian academic hospital between January 2014 and September 2015. We compared patients cared for in the
EDOU using the ischemic stroke protocol (study group) to eligible patients cared for before protocol im-
plementation (baseline group), as well as to eligible patients treated after protocol introduction but managed
without the EDOU protocol (contemporary reference group). We analysed three quality of care measures: aspirin
administration, physical therapy consultation, and swallow evaluation. We also analysed ED and hospital LOS as
measures of efficiency.
Results: Patients receiving protocolized EDOU care achieved higher care quality compared to the baseline group,
with higher rates of aspirin administration (91% v. 17%, p < 0.001), physical therapy consultation (50% v.
9.6%, p < 0.001), and swallow evaluation (36% v. 3.7%, p < 0.001). We observed similar improvements in
the study group compared to the contemporary reference group. Most patients (92%) were managed entirely in
the ED or EDOU. LOS for non-admitted patients was longer in the study group than the baseline group (28 v.
19 h, p = 0.023).
Conclusion: Protocolized EDOU care for patients with ischemic stroke in Haiti improved performance on key
quality measures but increased LOS, likely due to more interventions. Future studies should examine the aspects
of EDOU care are most effective at promoting higher care quality, and if similar results are achievable in patients
with other conditions.
tional challenges including emergency department (ED) overcrowding and prolonged patient length of stays
(LOS). In high-resource settings, protocolized ED observation unit (EDOU) care reduces LOS while preserving
care quality. EDOUs are untested in low-income countries. We evaluate the effect protocolized EDOU care for
ischemic stroke on the quality and efficiency of care in Haiti.
Methods: We performed a prospective cohort study of protocolized observation care for ischemic stroke at a
Haitian academic hospital between January 2014 and September 2015. We compared patients cared for in the
EDOU using the ischemic stroke protocol (study group) to eligible patients cared for before protocol im-
plementation (baseline group), as well as to eligible patients treated after protocol introduction but managed
without the EDOU protocol (contemporary reference group). We analysed three quality of care measures: aspirin
administration, physical therapy consultation, and swallow evaluation. We also analysed ED and hospital LOS as
measures of efficiency.
Results: Patients receiving protocolized EDOU care achieved higher care quality compared to the baseline group,
with higher rates of aspirin administration (91% v. 17%, p < 0.001), physical therapy consultation (50% v.
9.6%, p < 0.001), and swallow evaluation (36% v. 3.7%, p < 0.001). We observed similar improvements in
the study group compared to the contemporary reference group. Most patients (92%) were managed entirely in
the ED or EDOU. LOS for non-admitted patients was longer in the study group than the baseline group (28 v.
19 h, p = 0.023).
Conclusion: Protocolized EDOU care for patients with ischemic stroke in Haiti improved performance on key
quality measures but increased LOS, likely due to more interventions. Future studies should examine the aspects
of EDOU care are most effective at promoting higher care quality, and if similar results are achievable in patients
with other conditions.
Creator
Shada A. Rouhani, Regan H. Marsh, Linda Rimpel, Kathryn Anderson, Malena Outhay, Marie Cassandre Edmond, Keegan A. Checkett, Aaron L. Berkowitz, Gene F. Kwan, Christopher W. Baugh, Jeremiah D. Schuur
Source
https://doi.org/10.1016/j.afjem.2020.05.007
Date
20 May 2020
Contributor
peri irawan
Format
pdf
Language
english
Type
text
Files
Citation
Shada A. Rouhani, Regan H. Marsh, Linda Rimpel, Kathryn Anderson, Malena Outhay, Marie Cassandre Edmond, Keegan A. Checkett, Aaron L. Berkowitz, Gene F. Kwan, Christopher W. Baugh, Jeremiah D. Schuur, “Jurnal Internasional Afrika vol.10 issue.3 2020
African Journal of Emergency Medicine
Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti,” Repository Horizon University Indonesia, accessed March 14, 2025, https://repository.horizon.ac.id/items/show/1819.
African Journal of Emergency Medicine
Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti,” Repository Horizon University Indonesia, accessed March 14, 2025, https://repository.horizon.ac.id/items/show/1819.