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Strengthen digestive surgical emergency care: Experience of an action-research in Zinder National Hospital, Niger

par Adamou, Harissou;Adamou Magagi, I;Habou, O;Karimou, S;Halidou, M;Adamou, M;Labat, Aline
Référence European Congress on Tropical Medicine and International Health(10: 16-20/10/2017: Antwerpen), TM & IH. Tropical medicine and international health, TM & IH. Tropical medicine and international health (22), 5P80
Publication Publié, 2017-10

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Résumé :

Introduction Digestive surgical emergency care in Zinder national hospital is facing various dysfunctions which affect integration and continuity of care (low level of reference, delay in care, high mortality). An action-research is being conducted to verify if a better counter-reference is a good leverage to indirectly strengthen the primary health care professionals’ skills, enabling them to better refer and reduce the delay to ensureeffective care by the surgical team.Aim The first step of that action-research consisted in setting up a quality circle in the hospital to boost the surgical team and identify together ways to improve the quality of digestive emergency care. The first activity was the professionals’ skills strengthening in health care quality insurance and case management. Then the quality circle decided to counter-refer patients to the health facility of origin more systematically. They also created a network of providers between the hospital and the integrated health centers, the objective of their list of contacts is to accelerate the emergency care. Routine data were analyzed to describe the base line situation (2013-2015) and to document the process during the year 2016.Results For the period 2013-2015, before the creation of the quality circle, digestive surgical emergency reference rate was 33.2% (313/943) and the counter-reference 2% (6/313). Since the beginning of the intervention, reference rate is not changing much (34%; 155/459) but the counter-reference increased considerably to 39% (61/155). The average delay before surgical intervention decreased from 8.5 h before the intervention to6.5 hours.Conclusion The first step of that research-action allowed to boost the digestive surgical team which communicates more effectively since then and increased considerably the counterreference rate even if more efforts have to be done. A second step is analyzing the patient pathway inside the hospital to identify other bottlenecks and enhance the digestive emergency care.