1. Dr. Colin Gilhooley

2.  Introduce myself  Background of Jinja Hospital  Triage  Emergency Care

3.  Paediatric consultant  Head of Department of Paediatrics

5.  Paediatrics on separate site to main hospital  (SCU at main hospital)  Consultants 3  MO 1  Interns 3  Clinical officers 5  Nurses 19 (+ 5 nursing assistants)  2 lab staff  2 pharmacy technicians

6.  Patients/day 70-200  Admission/day 30-35  Inpatient mortality 4-6%  Conditions: malaria/pneumonia

10.  100-200 patients/day  increased on clinic days  Performed by student nurses  Overseen by Nurse Observations: Temperature Weight MUAC

11.  100-200 patients/day  Approx 25 – 35 admissions per day

12.  6 cots  10-12 patients in ED  1 nurse  Intern review every morning and evening  Some MO officer cover during day

13.  1 oxygen concentrator  Recurrent shortage of blood  Reasonable supply of antibiotics  Reasonable supply of antimalarials

15.  Paediatric Registrar  Work at Nottingham Children’s Hospital  Interest in Emergency Paediatrics

17.  Evaluate  Raise awareness  Implement Changes

18.  Busy = Long wait  If a child was noted to be very unwell would go to Emergency Department.  No formal process for recognising the “sick child”

19.  CMEs  Triage  Recognition and treatment of the acutely unwell child  Posters  Informal discussions  Actions

20.  Observations  Resp Rate  Assessment of pallor  Recognition  Understanding of emergency signs  Understanding of priority signs

21.  Student nurses change every 2 weeks.  Teach one group and then another group arrive  Acute presentations sit alongside outpatient reviews.  Accuracy of information.

22.  Start again!!  Use of pulseoximeter?  Stratify waiting area into acute vs outpatient

24.  Evaluation  Raise awareness  Implement Changes

25.  Unwell children still waited in a queue outside emergency department  Severely anaemic children not always put into oxygen.  Lack of standarised approach to management

26.  CMEs  Focused on conditions  Focused again on ETAT style approach  Focused on MoH guidelines  Mentoring  Aimed at nurses in ED

27.  Ask parent/carer why patient has been sent to ED  Coherent approach to presentations, not diagnoses.  Introduction of guidelines  Mortality review and prescription audit

28.  Lack of oxygen/blood  MoH guidelines vs work load  Motivation

29.  More of the same  Use audits and mortality reviews to monitor change and influence practice.  Identify health workers to continue work for the long term

31.  Some improve has occurred  Speed of access to ED - anecdotal  Awareness  More simple steps can be taken  Long term plan with skilled local involvement still needs to be put in place