Portrait of the Emergency Department at Orotta National Referral and Teaching Hospital in Asmara, Eritrea: A Prospective Observational Study

Samuel Tekle Mengistu; Oliver Okoth Achila; Simon Tesfay Negash; Yonathan Tesfaldet; Naod Yeibyo Tewolde; Nahom Asmerom Yohannes; Peniel Tsehaye Embaye; Fanus Yemane; Beyene Abraha; Goitom Hagos; Yoseph Tewolde

doi:10.2147/OAEM.S352638

Portrait of the Emergency Department at Orotta National Referral and Teaching Hospital in Asmara, Eritrea: A Prospective Observational Study

Open Access Emerg Med. 2022 Apr 28:14:195-215. doi: 10.2147/OAEM.S352638. eCollection 2022.

Affiliations

¹ Nakfa Hospital, Ministry of Health Northern Red Sea Branch, Nakfa, Eritrea.
² Department of Clinical Laboratory Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea.
³ Adi Keih Hospital, Adi-Keih, Eritrea.
⁴ Akurdet Hospital, Akurdet, Eritrea.
⁵ Ghindae Hospital, Ghindae, Eritrea.
⁶ Gedem Naval Hospital, Gedem, Eritrea.
⁷ Department of Clinical Sciences, Orotta College of Medicine and Health Sciences, Asmara, Eritrea.
⁸ Department of Internal medicine, Orotta College of Medicine and Health Sciences, Asmara, Eritrea.
⁹ Department of Surgery, Orotta College of Medicine and Health Sciences, Asmara, Eritrea.

Abstract

Background: Provision of high-quality emergency care for acute, life-threatening illnesses can significantly reduce DALY and mortality in sub-Saharan Africa. Here, we present data on the profile of an Emergency Department (ED) in the largest referral hospital in Eritrea and potential gaps for intervention.

Patients and methods: This was a prospective single-center observational study of 1093 patients who presented to the ED between September and October of 2020. Data were collected using a questionnaire from the patients' interview, observation and medical record review. The data were summarized using descriptive statistics and where applicable logistic regressions were performed.

Results: The median age was 45.0 years among the patients. In terms of acuity, 741 (68.5%), 283 (26.2%), 48 (4.4%), 10 (0.9%) patients were triaged as green, yellow, red, and black, respectively. In addition, the number of self-referred patients was 857 (79.1%) and among all the visitors, 376 (34.9%) used Ambulance service. The median ± IQR for ED length of stay (LOS) was 2.7 (1.4-10.0) Hours. Further, 154 (14.4%) patients stayed in the ED for >24 hours. The hospitalization rate was 146 (14.7%). In the multivariate analysis, higher likelihood of prolonged ED LOS was observed in: medical department patients (aOR = 3.53, 95% CI = 2.03-6.14); patients referred from primary health-care centers (aOR = 2.63, 95% CI = 1.10-6.30) and hospital (aOR = 3.70, 95% CI = 2.15-6.37). Prolonged ED LOS was also associated with prior emergency visit (aOR = 1.96, 95% CI = 1.13-3.40); consultation (aOR = 12.27, 95% CI = 6.98-21.56); the need for inpatient admission (aOR = 2.34, 95% CI = 1.38-3.96); and the need for investigation and treatment (aOR = 2.03, 95% CI = 1.07-3.85).

Conclusion: Improvements regarding ED specialist personnel, inpatient ward capacity, availability of investigations throughout the day and night shifts, amendments in referral system, strengthening ED and critical care capacity in zonal referral hospitals, and access to quality care among the non-communicable disease patients may ameliorate most of the bottlenecks observed in this set-up.

Keywords: ED LOS; Eritrea; Sub-Saharan Africa; chief complain; emergency department; emergency medical services systems.

Grants and funding

This study has not received any funding.