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.