title: Emergency medicine in Zanzibar: the effect of system changes in the emergency department.
abstract: BACKGROUND
  Mnazi Mmoja Hospital is a tertiary hospital in Zanzibar serving a population of 1.2 million. The emergency department was overcrowded and understaffed and the hospital management initiated a quality improvement project. The aim of this article is to describe the approach, methods and main results of this quality improvement process.
  
  
  METHODS
  The Plan-Do-Study-Act (PDSA) method was used in a five-circle process. In addition, a consensus-based approach was performed to identify areas of improvement.
  
  
  RESULTS
  Over a period of 6 months, regular staff meetings were implemented, a registration system was developed and implemented, the numbers of patients with simple problems were reduced, a simple triage tool was developed and implemented and an emergency room was established.
  
  
  CONCLUSIONS
  Change and improvement in health care are achievable despite limited financial resources if a comprehensive, robust and simple system is used. Involvement of all stakeholders from the start, identification and use of change agents, regular feedback and a focus on human resources rather than equipment have been key factors for the success of this project.
authors.affiliation: Department of Anaesthesiology and Intensive care, Haukeland University Hospital, Bergen, Norway.
authors.forename: Oyvind
authors.initials: O
authors.lastname: Thomassen
authors.affiliation: Emergency Department Musgrove Park Hospital, Taunton, England UK.
authors.forename: Clifford
authors.initials: C
authors.lastname: Mann
authors.affiliation: Outpatient Department, Mnazi Mmoja Hospital, Zanzibar, Tanzania.
authors.forename: Juma Salum
authors.initials: JS
authors.lastname: Mbwana
authors.affiliation: Department of Anaesthesiology and Intensive care, Haukeland University Hospital, Bergen, Norway.
authors.forename: Guttorm
authors.initials: G
authors.lastname: Brattebo
keywords: Emergency department; Emergency medicine; Low-income countries; Quality improvement