Hospital management in an acute conflict setting – the Aden experience

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!