title: Management and Outcomes of Acute Surgical Patients at a District Hospital in Uganda with Non-physician Emergency Clinicians.
abstract: Acute surgical care services in rural Sub-Saharan Africa suffer from human resource and systemic constraints. Developing emergency care systems and task sharing aspects of acute surgical care addresses many of these issues. This paper investigates the degree to which specialized non-physicians practicing in a dedicated Emergency Department contribute to the effective and efficient management of acute surgical patients.
  
  
  
  This is a retrospective review of an electronic quality assurance database of patients presenting to an Emergency Department in rural Uganda staffed by non-physician clinicians trained in emergency care. Relevant de-identified clinical data on patients admitted directly to the operating theater from 2011 to 2014 were analyzed in Microsoft Excel.
  
  
  
  Overall, 112 Emergency Department patients were included in the analysis and 96% received some form of laboratory testing, imaging, medication, or procedure in the ED, prior to surgery. 72% of surgical patients referred by ED received preoperative antibiotics, and preoperative fluid resuscitation was initiated in 65%. Disposition to operating theater was accomplished within 3 h of presentation for 73% of patients. 79% were successfully followed up to assess outcomes at 72 h. 92% of those with successful follow-up reported improvement in their clinical condition. The confirmed mortality rate was 5%.
  
  
  
  Specialized non-physician clinicians practicing in a dedicated Emergency Department can perform resuscitation, bedside imaging and laboratory studies to aid in diagnosis of acute surgical patients and arrange transfer to an operating theater in an efficient fashion. This model has the potential to sustainably address structural and human resources problems inherent to Sub-Saharan Africa's current acute surgical care model and will benefit from further study and expansion.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 120 Peterborough St Apt #4, Boston, MA, 02215, USA. calebdresser@gmail.com.
authors.forename: Caleb
authors.initials: C
authors.lastname: Dresser
authors.affiliation: Global Emergency Care Collaborative, Kampala, Uganda.
authors.forename: Usha
authors.initials: U
authors.lastname: Periyanayagam
authors.affiliation: Department of Emergency Medicine, University of Arizona College of Medicine, Kampala, Uganda.
authors.forename: Brad
authors.initials: B
authors.lastname: Dreifuss
authors.affiliation: Department of Surgery, Makerere University, Kampala, Uganda.
authors.forename: Robert
authors.initials: R
authors.lastname: Wangoda
authors.affiliation: Department of Surgery, Karoli Lwanga Hospital Nyakibale, Kampala, Uganda.
authors.forename: Julius
authors.initials: J
authors.lastname: Luyimbaazi
authors.affiliation: Global Emergency Care Collaborative, Kampala, Uganda.|Division of Emergency Medicine, Department of Surgery, University of Vermont Medical Center, Burlington, VT, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bisanzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods / Q000592:standards*; D005260:Female; D005440:Fluid Therapy; D005500:Follow-Up Studies; D006767:Hospitals, District; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011300:Preoperative Care; D012189:Retrospective Studies; D019035:Rural Health Services / Q000592:standards*; D013514:Surgical Procedures, Operative; D013997:Time Factors; D014454:Uganda; D000078329:Workforce; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents