The St Francis Referral Hospital in Ifakara, Tanzania, serves as a referral Center for a rural population of ~1.5 million people. Its emergency department (ED) manages 88.000 patients per year, 10% in a serious condition. To further stabilize seriously sick patients who were successfully managed at the emergency room, and for patients who received surgery, an intermediate care unit is needed.
The overall objective is to implement an Intermediate Care (IMC) Unit serving for about 1000 patients per year. We aim to substantially reduce the morbidity and mortality of seriously ill patients who were stabilized at the emergency room and need further intermediate care, or received surgery.
The primary objective is to train health care staff in intermediate care medicine and nursing.
Secondary objectives are i) to organize the clinical work at the IMC; ii) to organize the collaboration between IMC, ED, surgical theatre, and specialized clinics; iii) to implement equipment; and iv) to perform research, in order to be able to determine indicators of success.
- Number of health care personnel with skills / completed trainings, and trained trainers
- Number of patients managed at the IMC, and proportion of patients who survived
- Number of equipment implemented that work well
Training: 2 x 1 week intensive course, e-learning, and training during every day practice, in collaboration with the University Hospital Basel, Switzerland
- Management of trauma, stroke, sepsis, heart failure, arrhythmia, respiratory failure, serious obstetric and gynecological problems, bleeding conditions, and other serious conditions
- Detection and management of worsening of conditions
- Volume management
- Blood transfusion management
- Indication and application of vasoactive drugs
- Antibiotic stewardship
- Use of Point of care ultrasound
- Advanced Cardiac Live Support (ACLS) and Advanced Trauma Life Support (ATLS)
- Operation, interpretation, and maintenance of patient monitors
- Perform and to interprete electrocardiograms (ECG)
- Operation and maintenance of oxygen systems and respirators
- Operation and maintenance of infusion pumps and infusion devices
- Non-invasive ventilation
- Invasive procedures (e.g urinary catheters, central venous catheters, chest tube and others under sterile conditions, ultrasound-guided
- Physiotherapy of patients, especially those with a stroke
- Organisation of a three-shift working roster including nurses and at least one doctor per shift who stays at- and is responsible for IMC-patients
- Organisation of the close collaboration of the IMC doctors with the specialized department teams
- Organisation of patient flow from the emergency department and theatres to IMC and later to the wards. Implementation of a communication systems between these units
- Organisation of a rapid diagnosis and therapy for stroke patients who are presenting within 4.5 hours after first symptoms (i.e emergency department- rapid transport to Good Samaritian Hospital for CT scan and initiation of thrombolysis if no intracranial hemorrhage is present
- Organisation of visits for relatives of the patients.
Implemention of Equipment
- Implementation of 8 patient monitors, 4 respirators for non-invasive ventilation, ultrasound for point of care ultrasound, ECG machine and defibrillator, point of care lab system, suction machine, and chest drain system
- All equipment protected by stabilizer
IMC patients will be charged a regular admission fee – similar to the ER service. All services done will be charged at a reasonable price. Patients who cannot pay these fees, may get a waiver from payment. Salaries for nurses and one doctor will be paid by SFRH, two local medical doctors and one nurse certified in Intensive care nursing will be paid by project money. After 3-4 years, the project will be handed over to the hospital. Since income will increase over the project period, the IMC should be able to generate enough income to pay for maintenance of the IMC staff. All staff will remain employed, because from the beginning, the salary of most staff is already paid by the Hospital. The collaboration between the partners will remain as it is since decades, and training and teaching will go on through daily bed side teaching and regular courses by trained local nurses and doctors. Thanks to the “train the trainers” concept, knowledge and skills can be transferred to more health care staff in future.
The IMC will add to the local health care system consisting of referral from primary health care facilities- ED- surgical theatre-IMC, and reduce morbidity and mortality of severely sick patients. It will be a nation-wide model, to be implemented in other hospitals.
This will be the first intermediate care unit in rural areas in Tanzania.