Hospital management in an acute conflict setting: the Aden experience Lamia Bezer
ADEN TRAUMA CENTER ER CASE SEVERITY ADEN TRAUMA CENTER, APRIL-JUNE 2015
57 183
90 294
849
691
281
339
6 160 5 81 98 44
239 85
SURGICAL ACTIVITY BY TYPE Jan-July 2015 Aden Trauma Center Gynaecology
Minor
Orthopaedics
Specialized
Visceral
Wound
START OF CONFLICT
315 283
179
94
124
18 6 18 16 1
12 5 18 11 1
54 18 29 12 0
263
227
25 9 38 35 0
43 15 50 44 0
58 15 63 34 3
99 30 84 40
IPD admissions-outcome Aden Trauma Center 2015 discharges
Deaths
Referrals
Defaulters
Admissions
317 200 176 99
184
136 76 82
220 136
113 346 171
IPD BOR: up to 118%
324
IMMEDIATE ISSUES CAPACITY
TOTAL PTS ADMITTED: 105-110
• IPD 45 to 80 (excluding mattresses) ipd 1-2-3-4-female/children-lt-physio • ICU 7 up to 14-16 • ER 4 bays total up to 11 (6 R+5Y excluding mattresses) Small ER setup for small MCP ( < 30 pts)
OLD ER
Yellow zone
Yellow zone Red zone
MATTRESSES
IMMEDIATE ISSUES CAPACITY BLACK ROOM
AND PLASTIC BAGS…
IMMEDIATE ISSUES • • • • • •
ICU: 4 pulse oxymeter 2 dinamap No ventilator 1 suction machine 2 10lt O2 concentrators 5 5lt O2 concentrators
EQUIPMENT
N OF PTS: 12-14 ALS: 4 DAYS INCREASED THE MD/PT AND NURSE/PT RATIO 1 DOCTOR FOR 6 PTS 1 NURSE FOR 3
IMMEDIATE ISSUES HUMAN RESOURCES
•
•
EXPATS: scaling down – concentration of responsibilities on few key members NATIONAL STAFF: relocating, insecurity – decreased attendance
BURNOUT
IMMEDIATE ISSUES HUMAN RESOURCES
• •
NATIONAL STAFF: recruitments for medical positions mainly doctors ortho and general surgeons nurses Cleaners Identification of supervisors
IMMEDIATE ISSUES HUMAN RESOURCES
EXPAT STAFF: (when cq allows)increase surgical team to 1 anesth-1 nurse anesth-1 icu/er- 2 gen surg-1 ortho rest train and supervise the newly recruited staff to ensure quality of care
IMMEDIATE ISSUES MASS CASUALTIES
NEW MCP FROM 30.. TO 206 PTS
- > Staff on premises + on call - Clear setup - Instructions
CLEAR INSTRUCTIONS: WHO IS WHERE DOING WHAT
EACH WARD had detailed instructions for each staff during MCI
On call staff for large mci EVERYONE ELSE COMES AT THE SYREN…
Action cards
IMMEDIATE ISSUES “PREPAREDENESS”
ER SETUP • PRACTICAL (A-B-C-D-E) • IDENTICAL STRUCTURE FOR EACH BAY (NO CONFUSION) • MINIMAL MOVEMENT OF STAFF (OPTMISE RESUS TIME) • QUICK REFILL OF USED ITEMS (READINESS FOR NEXT PT)
OLD SETUP
NEW SETUP
OTHER ISSUES OT LIST
20150724_175823.jpg
1- urgent 2-delayed 3- planned
OTHER ISSUES: OT LIST “ “the ketamine corner”
• SSI 2.5%
• • •
Safety: Emergency trolley Airway mx (ett set) O2 anesth
Weekly Activity “Minor OT” DBR
DPC
DRESSING
OTHER
1 5 43
6 30
37
24
33
44
44 47
2 39 45
46
22
4
1
6
46
63
62
23 19
21 12
19 15
5 49 24 7
+DOUBLED THE CAPACITY OF OPD DRESSING ROOM 4 BEDS- 4 NURSES
OTHER ISSUES
PATIENTS FLOW - IDENTIFY PATIENTS FROM EARLY DISCHARGE (ICU +IPD) - IDENTIFY KEY PERSON TO FAST-TRACK DISCHARGE IN CASE OF MCI - CREATE HIGH ACUITY- LOW ACUITY AREAS - OTHER STRUCTURES TO ACCEPT NON ACUTE CASES (d/c home very difficult in war zones) – REFERRALS….
OTHER ISSUES SUPPLY
- Plan enough supply in advance - Optimise (rapid switch to oralalternative regimens, clinical needs) - Be creative - Local purchaseâ&#x20AC;Ś - emergency stock?
OTHER ISSUES
COOMUNICATION - PHONE - INTERNET sharing issues with coordination support from hq
Thank you!