Improving the time to pain relief in the emergency department through triage nurse-initiated analgesia - a quasi-experimental study from Ethiopia.

Introduction: Pain management is crucial for improving patients' quality of care. Persistent pain has been linked to higher depression, anxiety, and work-related difficulties. This study aimed to enhance the time to pain relief in the emergency department through triage nurse-initiated analgesia. It evaluated the impact of nurse-led analgesia on patient satisfaction compared to standard pain management at Tikur Anbessa Specialized Hospital and Kidus Paulos Specialized Hospital. Additionally, it compared the time to analgesia between the two hospitals and assessed the effect of nurse-led analgesia on reducing the length of stay for patients with pain. Methods: Using a quasi-experimental design, the study included an intervention group and a control group. Data was collected using an open data kit, and after ensuring data completeness, it was exported to SPSS and Excel for analysis. To assess the effectiveness of the intervention, the time to analgesia was compared between the intervention and control groups using an independent samples t-test. This statistical test allowed for a comparison of the mean time to analgesia between the two groups.Patient satisfaction scores were also compared between the intervention and control groups using the Mann-Whitney U test. Kaplan-Meier curves were employed to compare the time to analgesia between the intervention and control groups within both settings. A point bi-serial correlation analysis was performed to examine the association between the length of stay and the intervention of nurse-led analgesia in both hospital settings. Result and discussion: The study enrolled 179 participants, with a median age of 34 years (range: 9-80) and 67% female. The most common events leading to pain were medical conditions (21%), followed by trauma/quarrel/war, fall accidents, and underlying diseases (15%, 13%, and 13%, respectively). There was a significant correlation between the degree of pain on arrival and time to analgesia. Additionally, a significant correlation (p < 0.01) was found between time to analgesia and patient satisfaction. Conclusion and recommendation: Implementing a nurse-led analgesia protocol in the emergency department is crucial for reducing time to analgesia and improving patient satisfaction. It is recommended to scale up this approach to other healthcare facilities by incorporating it into the nursing practice guidelines of the country.

Job performance and associated factors among nurses working in adult emergency departments at selected public hospitals in Ethiopia: a facility-based cross-sectional study.

BACKGROUND: Optimizing the performance level of nursing staff is crucial for the efficient functioning of hospitals and better patient health outcomes. However, published data on the job performance levels and associated factors of nurses in Ethiopia is limited. Therefore, this study aimed to assess the job performance and associated factors of nurses working in adult emergency departments at selected public hospitals in Addis Ababa, Ethiopia. METHODS: A facility-based cross-sectional study was conducted from March 25 to April 25, 2023, among 172 nurses working in the adult emergency departments of selected public hospitals in Addis Ababa, Ethiopia. A simple random sampling technique was used to select the study participants. Data were collected using pretested, self-administered structured questionnaires. Data were coded, entered into Epi-data version 4.6, and analyzed using Statistical Package for Service Solution (SPSS) Version 27.0.1 software. Data were summarized using descriptive statistics, including mean, frequency, and standard deviation. A binary logistic regression analysis was done to determine factors associated with the performance of nurses. The strength of the association was measured using an adjusted odd ratio (AOR) with a 95% confidence interval (CI), and a P-value < 0.05 was considered statistically significant. RESULTS: The majority of nurses, 70.5% (95% CI: 63.7-77.3), rated their job performance as good. Workload [AOR = 1.70 (95% CI: 1.19-2.44)], remuneration [AOR = 1.89 (95% CI: 1.35-2.67)], rewards [AOR = 1.50 (95% CI: 1.01-2.23)], objectives to be achieved [AOR = 1.88 (95% CI: 1.32-2.67)], and feedback on performance appraisals [AOR = 1.65 (95% CI: 1.17-2.33)] were identified as significantly associated with nurses' performance. CONCLUSION: While the majority of nurses rated their job performance as good, it is important to note that a relevant proportion of nurses rated their job performance as poor. The findings of this study identified that nurses' performance is influenced by several key factors, including workload, remuneration, rewards, objectives to be achieved, and feedback on performance appraisals. Our findings call for improving nurses' job performance; therefore, hospitals should consider implementing systems that effectively utilize performance appraisal results and recognize and encourage hardworking nurses.

Reducing the length of stay of cardiac patients in the Adult Emergency department by using a Quality improvement framework.

BACKGROUND: Crowding is now a familiar challenge in the Emergency Department that can lead to significant adverse outcomes, including reduced quality of care and increased length of stay. OBJECTIVE: Reduce cardiac patient length of stay from 72 h to 48 h in the Tikur Anbessa Specialized Hospital Adult Emergency department from August 16, 2021, to January 29, 2022, in Addis Ababa, Ethiopia. METHODS: Process mapping was done by members of the team working in the emergency department on patient treatment and divided into three categories. Problems were then identified in each category that contributed to prolonged stay length. The run chart was then used to display the data for analysis, and nonrandom variation was looked for using the four-run chart rules. RESULTS: Improved patient throughput in the Emergency Department (ED) was achieved, reducing the average length of stay from 78 h to 25 h by implementing the following change strategies: Streamlining morning discharge times by adjusting from the baseline of 9:10 AM to 9:00 AM; Enhancing patient handover processes to ensure 100% of patients are included on the handover form during transition hours; and Consistently assigning residents to the waiting area, resulting in a 100% presence rate. These changes effectively decreased the prolonged patient length of stay in the ED. CONCLUSION: Poor management support and staff integration were identified as the leading cause of prolonged patient stay. In conclusion, a bundle of interventions is necessary to reduce the prolonged patient length of stay.

Clinical profile and outcomes of trauma patients visiting the emergency department of a trauma center Addis Ababa, Ethiopia.

Introduction: The term traumatic injury refers to physical injuries that present quickly and with a great deal of severity. These injuries can result from blunt, penetrating, and other causes. The best patients' outcomes are achieved when all parts of a trauma care system are in place. In low-resource settings, these facilities are scarce and their requirements high. Identifying patient profiles and evaluating these in relation to patient outcomes will help to guide interventions and monitor progress. Methods: This study aimed to examine the clinical profile and outcomes of trauma patients at ALERT Hospital, Ethiopia's busiest national trauma center. A retrospective cross-sectional chart review of 362 patients admitted from January 2019 to December 2019 at Alert Hospital trauma and emergency department was conducted. Results: The male-to-female ratio was 2.5:1, with trauma more prevalent among those in the age group of 24-33. Comparatively more injuries 98 (27.1%) occur between 8 and 6 a.m. and 90 (24.9%) of patients were transported by ambulance to the hospital. Among patients referred to the hospital, 247 (68.2%) patients received pre-hospital treatment. Interpersonal Violence (IPV) accounts for 31.8% of all accidents, followed by Road Traffic Accidents (RTA), which account for 30.7%. The Kampala Trauma Severity score (KTS) II showed mild trauma (82.3%), moderate trauma (11%), and severe trauma account (6.6%). A total of 44.2% of the victims suffered soft tissue injuries and 24% suffered extremity fractures, with 11.3% sustaining polytrauma. The mortality rate was 3.6%, with RTA, head injury, polytrauma, the severity of the injury, and patients with CPR were statistically associated factors. Discussion: IPV and RTA were the two most frequent causes of injuries, with most trauma victims being young. A great deal of emphasis needs to be given to preventing injury and improving prehospital emergency services.

Knowledge, practice and associated factors of nurses towards prevention of catheter-associated urinary tract infection in intensive care unit of public hospitals administered by Federal Government in Addis Ababa, Ethiopia: a cross-sectional institutional-based study.

BACKGROUND: Urinary catheterization is one of the most common procedures performed in hospitals specifically, in the intensive care units and is associated with a high risk for acquired urinary tract infections. More than 70% of acquired urinary tract infections are due to catheter use. Nurses are the primary healthcare providers responsible for inserting and maintaining urinary catheters. The data regarding nurses' knowledge, practice and associated factors towards prevention of catheter-associated urinary tract infections are limited in Ethiopia. Therefore, this study aimed to assess the knowledge, practice, and associated factors of nurses towards prevention of catheter-associated UTIs in the Intensive Care Unit (ICU) of public hospitals in Addis Ababa, Ethiopia. METHODS: An institutional-based descriptive cross-sectional study was conducted from March 01 to April 15, 2021, among nurses working in the ICU of public hospitals in Addis Ababa, Ethiopia. All 204 nurses working in the ICU of four public hospitals were included in the study using the census sampling method. Data were collected using a pretested self-administered semi-structured questionnaire. Data were cleaned and entered into Epi data version 4.6 and analyzed using Statistical Package for Social Sciences version 26.0. Pearson Chi-square and Fischer exact tests were performed to see the association between independent and dependent variables. The level of significance is considered at P-value less than 0.05. RESULTS: A total of 184 nurses participated in the study, making a response rate of 90.2%. The mean (±SD) age of the study participant was 29.07(±4.78). The study findings showed that more than half (63.04%) of nurses had poor knowledge and 88(47.83%) of nurses had poor practice towards prevention of catheter-associated UTIs. In this study, there was a statistically significant association between professional work experience and nurses' knowledge in preventing catheter-associated UTIs (at P-value = 0.031). CONCLUSION: In this study, nurses' knowledge and practice towards the prevention of catheter-associated urinary tract infection was relatively poor. Professional work experience had a significant statistical association with the level of knowledge. Therefore, increasing the knowledge of nurses through appropriate educational programs and training on the preventive measures of device-associated infections was recommended to prevent catheter-associated UTIs.