Abstract
Objective
A vital component of a prehospital emergency care system is getting an injured patient to the right hospital at the right time. Process and information flow mapping are recognised methods to show where efficiencies can be made. We aimed to understand the process and information flows used by the prehospital emergency service in transporting community emergencies in Rwanda in order to identify areas for improvement.
Design
Two facilitated process/information mapping workshops were conducted. Process maps were
produced in real time during discussions and shared with participants for their agreement. They were further validated by field observations.
Setting
The study took place in two prehospital care settings serving predominantly rural and predominantly urban patients.
Participants
24 healthcare professionals from various cadres. Field observations were done on 49
emergencies across both sites.
Results
Two maps were produced, and four main process stages were described: (1) call triage by the dispatch/call centre team, (2) scene triage by the ambulance team, (3) patient monitoring by the ambulance team on the way to the health facility and (4) handover process at the health
facility. The first key finding was that the rural site had multiple points of entry into the system for emergency patients, whereas the urban system had one point of entry (the national emergency number); processes were otherwise similar between sites. The second was that
although large amounts of information were collected to inform decision-making about which health facility to transfer patients to, participants found it challenging to articulate the intellectual process by which they used this to make decisions; guidelines were not used for decision-making.
Discussion
We have identified several areas of the prehospital care processes where there can be
efficiencies. To make efficiencies in the decision-making process and produce a standard approach for all patients will require protocolising care pathways.
A vital component of a prehospital emergency care system is getting an injured patient to the right hospital at the right time. Process and information flow mapping are recognised methods to show where efficiencies can be made. We aimed to understand the process and information flows used by the prehospital emergency service in transporting community emergencies in Rwanda in order to identify areas for improvement.
Design
Two facilitated process/information mapping workshops were conducted. Process maps were
produced in real time during discussions and shared with participants for their agreement. They were further validated by field observations.
Setting
The study took place in two prehospital care settings serving predominantly rural and predominantly urban patients.
Participants
24 healthcare professionals from various cadres. Field observations were done on 49
emergencies across both sites.
Results
Two maps were produced, and four main process stages were described: (1) call triage by the dispatch/call centre team, (2) scene triage by the ambulance team, (3) patient monitoring by the ambulance team on the way to the health facility and (4) handover process at the health
facility. The first key finding was that the rural site had multiple points of entry into the system for emergency patients, whereas the urban system had one point of entry (the national emergency number); processes were otherwise similar between sites. The second was that
although large amounts of information were collected to inform decision-making about which health facility to transfer patients to, participants found it challenging to articulate the intellectual process by which they used this to make decisions; guidelines were not used for decision-making.
Discussion
We have identified several areas of the prehospital care processes where there can be
efficiencies. To make efficiencies in the decision-making process and produce a standard approach for all patients will require protocolising care pathways.
| Original language | English |
|---|---|
| Article number | e085064 |
| Number of pages | 10 |
| Journal | BMJ open |
| Volume | 14 |
| DOIs | |
| Publication status | Published - 25 Jun 2024 |