Are we ready? Emergency unit capacity at selected district level hospitals in Lusaka Province, Zambia: Barriers and facilitators for improving trauma care: a mixed methods approach

Abstract

The increasing burden of road traffic injuries (RTIs) has become a public health concern in Zambia for the last five years. Little is known about the capacity and determinants of emergency care at the point of first contact in a country without coordinated pre-hospital and emergency medical services (EMS). Evaluation of the in-hospital emergency trauma care for RTIs is critical. This study sought to assess the emergency care at the district level hospitals to effectively manage RTIs, using the WHO Hospital Emergency Assessment Tool (HEAT), and identify the barriers and facilitators. A mixed-methods approach was employed at ten facilities in Lusaka Province between May 2023 and September 2023. Quantitative data were collected using the WHO HEAT instrument on facility matrices, infrastructure and equipment, human resources, diagnostic and clinical services, and signal functions. Thirty-five interviews were conducted with emergency unit healthcare providers at these facilities to identify the barriers and facilitators to care. The WHO tool guided inductive and deductive thematic analysis. Emergency care services were available 24 hours a day, with a mean bed capacity of 4.7 for the ten (10) facilities sampled. Eight hospitals had a designated emergency unit and three had no triage area. Only four hospitals had a core emergency trauma team. The key barriers to care were shortage of equipment and consumables, a lack of skills and specialist services to perform signal functions, and inadequate ambulance services. However, supportive and committed leadership, team cohesiveness, interdepartmental collaboration, motivated staff, and skills transfer from seniors emerged as the facilitators to care. Lusaka Province is moderately prepared for the increasing number of emergency trauma cases. To strengthen emergency trauma care; capacity building for human resource in triage, resuscitation, and trauma interventions for the initial care is integral. Deliberate action through budgetary support for infrastructure development, emergency equipment procurement, increased ambulance service availability, and recruitment of skilled human resources is timely.

Fig 1. Methodology flow diagram.

Fig 2. Codebook for barriers and facilitators to emergency trauma care at selected district hospitals in Lusaka, Province.

Fig 3. Comparative facility level availability of infrastructure, equipment, diagnostic and point of care tests, case management protocols and trauma interventions across the selected Hospitals in Lusaka, Province.