Post on 10-Jul-2015
Adult Emergency & Trauma Centre
QECTH Blantyre Malawi
Barry KlaassenEmergency Medicine NHS Tayside
NHS Tayside
• Numerous individual projects
• Formation of Tayside Malawi Group
• Strong Health Board and Executive support
Tayside Malawi Group
• Aim bring together projects and share knowledge and expertise potential for collaboration/co-operation
• Chair Prof Frank Carey( Pathology)
• Now NHS Tayside Int. Heath Links Group
NHS Tayside Group
• Anaesthesia • General Practice • Obstetrics and Gynaecology• Pathology/laboratory Science• Plastic Surgery• Emergency Medicine• also PAMS and St.Andrews/Dundee
Medical Schools
Emergency project
• Anaesthetic/critical care training led by Dr Catriona Connelly Oct 2007 Part of that team
• Consulted on feasibility of Adult ED by Prof Malcolm Molyneux and Prof Rob Heyderman Director of Malawi Wellcome Trust
Queen Elizabeth Central Teaching Hospital
• Malawi’s largest 1,120 beds
• for local population approx 1 million
• Teaching hosp for single Medical School
Problems for QECTH
• 3 fold population increase
• urbanization
• HIV epidemic
• ALL increase GREATLY clinical workload
QECTH in 2006
• 400,167 attendances A&E/OP… 1500+/day• on average• 302 Paeds emergencies/day with 70
admissions/day• 530 adult emergencies/day max1010/day
with 70 med /20 surg admissions• bed occupancy in med admissions 252%
Problems with existing A&E facility
• Makeshift access• few small rooms/confined space• no triage facility/triage non-existent• no resuscitation facility • no capacity for major incident• no capacity to stabilise patients prior to
admit to wards
Establishment of Paediatric A&E Unit ( PAEU) 2001
• New build for rapid registration• immediate triage• on site immediate care• resuscitation facility• records and data store• senior clinical supervision• ability to deliver 1st treatments rapidly
Impact of PAEU
• DRAMATIC….• Reduction death rate among admissions
from 19% to 9%• improved research on acute conditions• improved teaching/support of staff and
Med/Nurse students• improve morale of all on-site staff
THERE IS NO EQUIVELENT PROVISION FOR…….
• Adult acute Medical
• Adult Surgical
• Adult Orthopaedic and Trauma
• or Gynaecological Conditions
Proposal
• Purpose built Adult Emergency & Trauma Centre
• QECTH/COM heads of Dept agree need for such
• appointed steering group• identified site at Hospital• Architects appointed / drafted initial plan
Requirements of Centre
• Capacity for 500-1000• immediate reg/triage• separate minor/majors• resuscitation facility• specialist evaluation• ability to isolate I.D• Short stay facility • ability to initiate 1st
treatment
• Capacity for data store• open plan waiting area• optimise flow to treat• minor/major theatres
& plaster areas• lab facilities• x-ray facilities• dispensing pharmacy
Further requirements
• Suitable to senior supervision all areas
• teaching/training facilities/seminar room
• amenities for staff rest/refreshment
• Adequate toilet/wash facilities for patients
• max air flow & natural light throughout unit
• ready access for Amb.
Funding
• Malawi- Liverpool-Wellcome Trust pledged excess of £500,000
• THIS REMAINS CONFIDENTIAL BUT IS CONFIRMED.
• This covers new build costs
Require further funding for ..
• Initial key set up personnel
• Equipment costs
• Training Costs
Scottish support
• Recruit Experienced Scottish EM Consultant to oversee initial operation
• Support re equipment purchase
• support re training Malawian clinical staff
Tayside EM dept involvement
• Support project and provide a link for new dept akin to Twinning arrangement
• share good practice and equipment
• allow senior Malawian Clinical staff to come and observe our EM practice
Tayside EM Benefits
• Opportunity to share some of our expertise with others
• contribute collectively as a unit in framework of Scottish Gov policy to Malawi
• opportunity to use the link to generate research and audit collaboratively
• Develop improved understanding of EM as practised in other country
Funding
• Scottish Gov. International Development Fund
• NHS Tayside funds with Malawi support group
• Local Fund raising • Others…
Scottish Gov IDF Grant
• Not payable to individual need to be organisation
• NHS Tayside Director of Finance very supportive
• Have created NHS Tayside Malawi-EM project endowment fund
Additional Expenditure
• Recruit a Clinical Lead for Unit -College of Medicine responsibility
• Recruit Nursing Staff , New Clinical Officers and Eventually Medical Staff - Ministry of Health responsibility
SOMEONE CANNOT DO EVERYTHING…
…BUT EVERYONE CAN DO SOMETHING.
ANY QUESTIONS?