Muhimbili National Hospital in Dar Es Salaam, Tanzania
Muhimbili National Hospital (MNH) in Dar Es Salaam is Tanzania's largest public hospital and the country's leading teaching and referral center with 1,500 beds. The emergency department (ED) at MNH opened in 2010 and is home to one of few emergency medicine residencies in Africa, and sees nearly 40,000 patients annually. As part of an effort through the African Federation for Emergency Medicine (AFEM), I spent 2 weeks in March 2015 at MNH, holding focus groups with local administrators, physicians, and nurses to assess the feasibility and acceptability of AFEM's newly developed tool for documenting medical emergencies in low-resource emergency departments (EDs).
Poor clinical documentation and medical recordkeeping are key obstacles to improving emergency care in low-resource settings since they not only obscure patients' clinical course and leads to errors and poor outcomes, but also complicates systematic data collection and evaluation. In many parts of the world, clinical encounters are documented by hand on blank pieces of paper, classically in the "SOAP" format of Subjective, Objective, Assessment, and Plans. Frequently, given the high volume of critically ill patients seen throughout the day in many EDs, clinicians spend minimal time on documentation. As a result, charts are often difficult to interpret due to haphazard documentation or indecipherable handwriting. The goal of this project was to optimize a tool designed to simplify and standardize medical documentation in order to improve individual patient care and systematic data collection that ultimately boosts our understanding of the role of emergency care in low-resource settings.
The AFEM tool was modeled after a trauma documentation system that has been adopted as the chart for all trauma patients presenting to participating EDs across Africa. As a participating ED, MNH physicians had grown accustomed to the standardized trauma form, and had helpful insights into the use of standardized documentation in emergency settings and valuable suggestions for improving the newly designed form. Many expressed that while they were initially hesitant to adopt an entirely new way of documenting clinical encounters, they found that standardized forms not only saved time and mental energy during busy ED shifts, but also served as a "checklist" of must-do tasks. With these comments and suggestions in mind, I next headed to Blantyre, Malawi to find out how a different group of clinicians in a different clinical setting would find the AFEM tool.