Assessment of quality of emergency care and outcome of severely ill children at Kenyatta National hospital
Abstract
Introduction: Infant and childhood mortality rates have remained very high in developing
countries. In these countries there is little information on the quality of hospital care available for
severely sick children or its relation to outcome.
Objective: To audit the quality of emergency care given to. and the outcome of, severely
ill children attending the Kenyatta National Hospital (KNH).
Methods: An inventory of essential emergency equipment and drugs as well as personnel
at the Paediatric Filter Clinic. (PFC) of the hospital was taken. A prospective longitudinal
audit was then carried out at the PFC and paediatric general wards. Severely ill children
were recruited and followed up for a period of one week. The quality of emergency care
rendered was described in terms of the rapidity as well as the appropriateness of the
emergency care given as described in the Emergency Triage and Treatment (ETA.T)
guidelines. The outcomes were described at the PFC, at 24 hours and at the end of one
week.
Results: Of the 46 items of essential emergency equipment and drugs. 91 3010 were
available at the PFC, The missing items included intra-osseous needles. 3rd-Generation
cephalosporins. Half-strength Darrow's Solution and treatment guideline charts for
hypoglycemia. Only one of the 33 nurses, six of 17 RCO's and none of the medical
interns working at the PFC had undergone ETAT training. The paediatrician and all the
post-graduate doctors had undergone the training. A total of 130 severely ill children
were recruited into the study. The most common presenting conditions were shock.
respiratory distress, diarrhea, wheezing and convulsion seen in 43 (33.1%),26 (20%).16
(12.3%), 15 (11.5%) and 12 (9.2%) of the patients respectively. The most common
illnesses after final diagnosis were gastroenteritis. pneumonia and meningitis representing
46 (35%), 39 (30%) and 18 (14%) of the patients respectively. Of the 78 patients whose
timing was well recorded 75.6% were attended within five minutes of their arrival at the
hospital. Although 117 (90%) received the appropriate initial emergency interventions.
92 (70.8%) did not to have the required laboratory investigations performed at the PFC.
The overall mortality at the end of one week was 20%. Five patients died at the PFC. 11
died within 24 hours after admission and another 10 died between 24 hours and one
week. The leading causes of death were gastroenteritis, pneumonia and meningitis
accounting for 7 (26.9%),6 (23%) and 5 (19.2%) of the deaths respectively.
Conclusions: With the exception of the few missing essential emergency items the PFC
was well equipped. The number of ETAT- trained nurses, RCO' s and medical interns
was low. The initial laboratory investigations were poorly conducted. The overall
mortality was high especially within the first 2-1-hours after the patients' presentation to
the hospital. It is recommended that more staff should be trained in the principles of
ETAT and that conduction of basic investigations at the PFC should be improved.
Citation
Master of medicine in paediatrics and child healthSponsorhip
University of NairobiPublisher
School of Medicine, University of Nairobi