Evaluating capacity at three government referral hospital emergency units in the kingdom of Eswatini using the WHO Hospital Emergency Unit Assessment Tool

• Type of Material: Article
• Authors: Jenn L. Pigoga, University of Cape Town; A. P. Joiner, Duke University; Erika Chowa, Emory University; J. Luong, Ohio State University; M. Mhlanga, Eswatini Ministry of Health; T. A. Reynolds, World Health Organization; L. A. Wallis, University of Cape Town
• Language: English
• Date: 2020-05-06
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2020
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12873-020-00327-w
• Title of Journal or Parent Work: BMC EMERGENCY MEDICINE
• Grant/Funding Information: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
• Keywords: health system development; emergency medicine; emergency care; global health
• Research Categories: Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Background: The Kingdom of Eswatini, a lower-middle income nation of 1.45 million in southern Africa, has recently identified emergency care as a key strategy to respond to the national disease burden. We aimed to evaluate the current capacity of hospital emergency care areas using the WHO Hospital Emergency Unit Assessment Tool (HEAT) at government referral hospitals in Eswatini. Methods: We conducted a cross-sectional study of three government referral hospital emergency care areas using HEAT in May 2018. This standardised tool assists healthcare facilities to assess the emergency care delivery capacity in facilities and support in identifying gaps and targeting interventions to strengthen care delivery within emergency care areas. Senior-level emergency care area employees, including senior medical officers and nurse matrons, were interviewed using the HEAT. Results: All sites provided some level of emergency care 24 h a day, 7 days a week, though most had multiple entry points for emergency care. Only one facility had a dedicated area for receiving emergencies and a dedicated resuscitation area; two had triage areas. Facilities had limited capacity to perform signal functions (life-saving procedures that require both skills and resources). Commonly reported barriers included training deficits and lack of access to supplies, medications, and equipment. Sites also lacked formal clinical management and process protocols (such as triage and clinical protocols). Conclusions: The HEAT highlighted strengths and weaknesses of emergency care delivery within hospitals in Eswatini and identified specific causes of these system and service gaps. In order to improve emergency care outcomes, multiple interventions are needed, including training opportunities, improvement in supply chains, and implementation of clinical and process protocols for emergency care areas. We hope that these findings will allow hospital administrators and planners to develop effective change management plans.