SMP - Barry Klassen

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SMP - Barry Klassen

  1. 1. Adult Emergency & Trauma Centre QECTH Blantyre Malawi Barry Klaassen Emergency Medicine NHS Tayside
  2. 3. NHS Tayside <ul><li>Numerous individual projects </li></ul><ul><li>Formation of Tayside Malawi Group </li></ul><ul><li>Strong Health Board and Executive support </li></ul>
  3. 4. Tayside Malawi Group <ul><li>Aim bring together projects and share knowledge and expertise potential for collaboration/co-operation </li></ul><ul><li>Chair Prof Frank Carey( Pathology) </li></ul><ul><li>Now NHS Tayside Int. Heath Links Group </li></ul>
  4. 5. NHS Tayside Group <ul><li>Anaesthesia </li></ul><ul><li>General Practice </li></ul><ul><li>Obstetrics and Gynaecology </li></ul><ul><li>Pathology/laboratory Science </li></ul><ul><li>Plastic Surgery </li></ul><ul><li>Emergency Medicine </li></ul><ul><li>also PAMS and St.Andrews/Dundee Medical Schools </li></ul>
  5. 6. Emergency project <ul><li>Anaesthetic/critical care training led by Dr Catriona Connelly Oct 2007 Part of that team </li></ul><ul><li>Consulted on feasibility of Adult ED by Prof Malcolm Molyneux and Prof Rob Heyderman Director of Malawi Wellcome Trust </li></ul>
  6. 8. Queen Elizabeth Central Teaching Hospital <ul><li>Malawi’s largest 1,120 beds </li></ul><ul><li>for local population approx 1 million </li></ul><ul><li>Teaching hosp for single Medical School </li></ul>
  7. 9. Problems for QECTH <ul><li>3 fold population increase </li></ul><ul><li>urbanization </li></ul><ul><li>HIV epidemic </li></ul><ul><li>ALL increase GREATLY clinical workload </li></ul>
  8. 10. QECTH in 2006 <ul><li>400,167 attendances A&E/OP… 1500+/day </li></ul><ul><li>on average </li></ul><ul><li>302 Paeds emergencies/day with 70 admissions/day </li></ul><ul><li>530 adult emergencies/day max1010/day with 70 med /20 surg admissions </li></ul><ul><li>bed occupancy in med admissions 252% </li></ul>
  9. 11. Problems with existing A&E facility <ul><li>Makeshift access </li></ul><ul><li>few small rooms/confined space </li></ul><ul><li>no triage facility/triage non-existent </li></ul><ul><li>no resuscitation facility </li></ul><ul><li>no capacity for major incident </li></ul><ul><li>no capacity to stabilise patients prior to admit to wards </li></ul>
  10. 15. Establishment of Paediatric A&E Unit ( PAEU) 2001 <ul><li>New build for rapid registration </li></ul><ul><li>immediate triage </li></ul><ul><li>on site immediate care </li></ul><ul><li>resuscitation facility </li></ul><ul><li>records and data store </li></ul><ul><li>senior clinical supervision </li></ul><ul><li>ability to deliver 1st treatments rapidly </li></ul>
  11. 19. Impact of PAEU <ul><li>DRAMATIC…. </li></ul><ul><li>Reduction death rate among admissions from 19% to 9% </li></ul><ul><li>improved research on acute conditions </li></ul><ul><li>improved teaching/support of staff and Med/Nurse students </li></ul><ul><li>improve morale of all on-site staff </li></ul>
  12. 21. THERE IS NO EQUIVELENT PROVISION FOR……. <ul><li>Adult acute Medical </li></ul><ul><li>Adult Surgical </li></ul><ul><li>Adult Orthopaedic and Trauma </li></ul><ul><li>or Gynaecological Conditions </li></ul>
  13. 22. Proposal <ul><li>Purpose built Adult Emergency & Trauma Centre </li></ul><ul><li>QECTH/COM heads of Dept agree need for such </li></ul><ul><li>appointed steering group </li></ul><ul><li>identified site at Hospital </li></ul><ul><li>Architects appointed / drafted initial plan </li></ul>
  14. 24. Requirements of Centre <ul><li>Capacity for 500-1000 </li></ul><ul><li>immediate reg/triage </li></ul><ul><li>separate minor/majors </li></ul><ul><li>resuscitation facility </li></ul><ul><li>specialist evaluation </li></ul><ul><li>ability to isolate I.D </li></ul><ul><li>Short stay facility </li></ul><ul><li>ability to initiate 1st treatment </li></ul><ul><li>Capacity for data store </li></ul><ul><li>open plan waiting area </li></ul><ul><li>optimise flow to treat </li></ul><ul><li>minor/major theatres & plaster areas </li></ul><ul><li>lab facilities </li></ul><ul><li>x-ray facilities </li></ul><ul><li>dispensing pharmacy </li></ul>
  15. 25. Further requirements <ul><li>Suitable to senior supervision all areas </li></ul><ul><li>teaching/training facilities/seminar room </li></ul><ul><li>amenities for staff rest/refreshment </li></ul><ul><li>Adequate toilet/wash facilities for patients </li></ul><ul><li>max air flow & natural light throughout unit </li></ul><ul><li>ready access for Amb. </li></ul>
  16. 26. Funding <ul><li>Malawi- Liverpool-Wellcome Trust pledged excess of £500,000 </li></ul><ul><li>THIS REMAINS CONFIDENTIAL BUT IS CONFIRMED. </li></ul><ul><li>This covers new build costs </li></ul>
  17. 27. Require further funding for .. <ul><li>Initial key set up personnel </li></ul><ul><li>Equipment costs </li></ul><ul><li>Training Costs </li></ul>
  18. 28. Scottish support <ul><li>Recruit Experienced Scottish EM Consultant to oversee initial operation </li></ul><ul><li>Support re equipment purchase </li></ul><ul><li>support re training Malawian clinical staff </li></ul>
  19. 29. Tayside EM dept involvement <ul><li>Support project and provide a link for new dept akin to Twinning arrangement </li></ul><ul><li>share good practice and equipment </li></ul><ul><li>allow senior Malawian Clinical staff to come and observe our EM practice </li></ul>
  20. 30. Tayside EM Benefits <ul><li>Opportunity to share some of our expertise with others </li></ul><ul><li>contribute collectively as a unit in framework of Scottish Gov policy to Malawi </li></ul><ul><li>opportunity to use the link to generate research and audit collaboratively </li></ul><ul><li>Develop improved understanding of EM as practised in other country </li></ul>
  21. 31. Funding <ul><li>Scottish Gov. International Development Fund </li></ul><ul><li>NHS Tayside funds with Malawi support group </li></ul><ul><li>Local Fund raising </li></ul><ul><li>Others… </li></ul>
  22. 32. Scottish Gov IDF Grant <ul><li>Not payable to individual need to be organisation </li></ul><ul><li>NHS Tayside Director of Finance very supportive </li></ul><ul><li>Have created NHS Tayside Malawi-EM project endowment fund </li></ul>
  23. 33. Additional Expenditure <ul><li>Recruit a Clinical Lead for Unit -College of Medicine responsibility </li></ul><ul><li>Recruit Nursing Staff , New Clinical Officers and Eventually Medical Staff - Ministry of Health responsibility </li></ul>
  24. 34. SOMEONE CANNOT DO EVERYTHING… …BUT EVERYONE CAN DO SOMETHING.
  25. 35. ANY QUESTIONS?

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