Jurnal Internasional Afrika vol. 9 issue 1 2019
African Journal of Emergency Medicine
Impact of emergency medicine training implementation on mortality outcomes in Kigali, Rwanda: An interrupted time-series study

Jurnal Internasional Afrika vol. 9 issue 1 2019
African Journal of Emergency Medicine
Impact of emergency medicine training implementation on mortality outcomes in Kigali, Rwanda: An interrupted time-series study

Emergency medicine
Training
Mortality
Rwanda
Africa

Introduction: Although emergency medicine (EM) training programmes have begun to be introduced in low- and
middle-income countries (LMICs), minimal data exist on their effects on patient-centered outcomes in such
settings. This study evaluated the impact of EM training and associated systems implementation on mortality
among patients treated at the University Teaching Hospital-Kigali (UTH-K).
Methods: At UTH-K an EM post-graduate diploma programme was initiated in October 2013, followed by a
residency-training programme in August 2015. Prior to October 2013, care was provided exclusively by general
practice physicians (GPs); subsequently, care has been provided through mutually exclusive shifts allocated
between GPs and EM trainees. Patients seeking Emergency Centre (EC) care during November 2012–October
2013 (pre-training) and August 2015–July 2016 (post-training) were eligible for inclusion. Data were abstracted
from a random sample of records using a structured protocol. The primary outcomes were EC and overall
hospital mortality. Mortality prevalence and risk differences (RD) were compared pre- and post-training.
Magnitudes of effects were quantified using regression models to yield adjusted odds ratios (aOR) with 95%
confidence intervals (CI).
Results: From 43,213 encounters, 3609 cases were assessed. The median age was 32 years with a male predominance
(60.7%). Pre-training EC mortality was 6.3% (95% CI 5.3–7.5%), while post-training EC mortality
was 1.2% (95% CI 0.7–1.8%), constituting a significant decrease in adjusted analysis (aOR=0.07, 95% CI
0.03–0.17; p < 0.001). Pre-training overall hospital mortality was 12.2% (95% CI 10.9–13.8%). Post-training
overall hospital mortality was 8.2% (95% CI 6.9–9.6%), resulting in a 43% reduction in mortality likelihood
(aOR=0.57, 95% CI 0.36–0.94; p=0.016).
Discussion: In the studied population, EM training and systems implementation was associated with significant
mortality reductions demonstrating the potential patient-centered benefits of EM development in resourcelimited
settings.

Adam R. Aluisio, Meagan A. Barry, Kyle D. Martin, Gabin Mbanjumucyo, Zeta A. Mutabazi, Naz Karim, Rachel T. Moresky, Jeanne D'Arc Nyinawankusi, Jean Claude Byiringiro, Adam C. Levine

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AFEM

4 October 2018

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