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?