Quality of Medical Care at the Emergency Departments of Public Hospitals in Kenya

Abstract

Globally, states are obliged to prioritize quality medical care at emergency departments (EDs). Kenya is not an exception since medical care services are mainly offered in the outpatient departments. However, the quality of care in these outpatient departments has not been evaluated. The aim of this study was to investigate quality of care at EDs of public hospital in Kenya, with a focus on Bungoma County. The study evaluated the availability of infrastructure, equipment, supplies and personnel. Besides, the researcher assessed processes, protocols, and outcomes of care at the Eds in Kenya’s public hospitals. A cross-sectional study design was employed, with a sample of 10 ED in-charges and 398 patients. The participants were proportionately recruited from the EDs via probability proportional to size (PPS). Quality of the EDS was measured using the Donabedian model with structure assessed by evaluating availability of infrastructure, equipment, supplies and personnel for emergency care. Process was evaluated by measuring turnaround timelines, assessment of presence and utilization of triage systems, protocols, and guidelines. Outcomes were measured using number of admissions, deaths, left without being seen, unplanned re-attendance, and patient service experience. Data collection was based on WHO observation checklists and with the help of questionnaires. The analysis consisted of descriptive and inferential statistics. The findings revealed that infrastructure availability was 42.0% with all EDs lacking resuscitation rooms and high dependency units. Secondly, imaging rooms were in 40% of the hospitals, blood banks in 50%, and running water in 70%. Third, equipment availability was 34.7% with oxygen source, pulse oximeter, point of care ultrasound and trauma cart being available in 10%. Fourth, regular maintenance of equipment was in 52.5% of the EDs. Finally, availability of supplies for resuscitation was 52% with Supplies for airway management being the least (22%). From the study, it was apparent that trained personnel, equipment, supplies and processes such of triage systems. This has contributed to prolonged turnaround time and high re-attendance rates. There is need for provision of adequate infrastructure, equipment, personnel, and systems for emergency care in public hospitals EDs in Bungoma County to improve quality of care.