Review Article
Volume 5 Issue 5 - 2021
Decision to Incision for Surgical Emergencies: The Practice and Challenges in a Low-Income Setting
Olubusola T Alagbe-Briggs1 and Rex Friday Ogoronte A Ijah2*
1Department of Anesthesia, University of Port Harcourt Teaching Hospital and Senior Lecturer, University of Port Harcourt Port Harcourt, Nigeria
2Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
*Corresponding Author: Rex Friday Ogoronte A Ijah, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
Received: April 12, 2021; Published: April 30, 2021




Abstract

Prompt attention to surgical emergencies has always been the standard of care intended to improve outcome and forestall negative consequences. Patients feel dissatisfied when delay is encountered in the care of their love ones. The objectives of this study were to investigate the awareness, practice and challenges associated with response to emergency surgical conditions at the University of Port Harcourt Teaching Hospital during the study period (April 2020 to January 2021). A mixed-method prospective/cross-sectional descriptive study was carried out between the months of April 2020 and January 2021 in a multispecialty tertiary healthcare facility using a proforma (for prospective data collection) and semi-structured questionnaires. A total of 105 respondents were recruited in the questionnaire survey, and 86 surgical procedures were recorded in the study proforma. All the respondents (100%) asserted positively to awareness of medico-legal issues in surgical practice and 96 (91.4%) were also aware of violence against health workers following perceived injustice to patients. There was significant prolongation of surgical intervention time was occasioned by occurrence of patient-related and hospital-related factors. The findings from the questionnaire-based survey was to a large extent corroborated by the data obtained from direct observation of practical experiences at the point of duty using study proforma. Emergency response practice was hindered by the challenges encountered at the point of duty, despite the high awareness of the caregivers. Insurance coverage for surgical patients and reduction in hospital-related sources of delay will improve emergency surgical services.

 

Keywords: Decision to Incision; Emergency Surgeries; Delays; Challenges; Port Harcourt

References

  1. Caesar U., et al. “Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years”. Patient Safety in Surgery1 (2018): 2.
  2. Urgent NE. “Emergency Care Review Team (2014) Transforming urgent and emergency care services in England: update on the Urgent and Emergency Care Review”. NHS England (NHS, 201Leeds) (2014).
  3. Marjanovic S., et al. “Transforming urgent and emergency care and the vanguard initiative: learning from evaluation of the southern cluster”. Rand Health Quarterly4 (2018).
  4. Manley K., et al. “Transforming urgent and emergency care together: developing standards for integrated facilitation in and about the workplace: Canterbury Christ Church University (2015).
  5. Turner J., et al. “Whole system solutions for emergency and urgent care”. UK: ScHARR University of Sheffield (2014).
  6. Mbah N., et al. “Waiting time among acute abdominal emergencies in a Nigerian teaching hospital: causes of delay and consequences”. Nigerian Journal of Surgical Research1 (2006).
  7. Moore B., et al. “Trends in emergency department visits, 2006–2014”. Rockville, MD: Agency for Healthcare Research and Quality (2017).
  8. Skinner HG., et al. “Trends in emergency department visits, 2006-2011: statistical brief# 179”. Rockville, MD: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs (2006).
  9. Arha G. “Reducing Wait Time Prediction In Hospital Emergency Room: Lean Analysis Using a Random Forest Model (2017).
  10. Kluger Y., et al. “World society of emergency surgery study group initiative on Timing of Acute Care Surgery classification (TACS)”. World Journal of Emergency Surgery 1 (2013): 1-6.
  11. Santry H., et al. “Acute care surgery patterns in the current Era: results of a qualitative study (2012).
  12. Coopers P. “Good practice in management of emergency surgery: a literature review”. In: Health Do, editor. Melbourn, Victoria: The Performance, Acute Programs and Rural Health Branch, Victorian Government Department of Health, Melbourne, Victoria (2010).
  13. Hsia RY., et al. “Factors associated with closures of emergency departments in the United States”. The Journal of the American Medical Association 19 (2011): 1978-1985.
  14. Pines JM., et al. “The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain”. Academic Emergency Medicine7 (2009): 617-625.
  15. Carr BG., et al. “Emergency department length of stay: a major risk factor for pneumonia in intubated blunt trauma patients”. Journal of Trauma and Acute Care Surgery1 (2007): 9-12.
  16. Chalfin DB., et al. “Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit”. Critical Care Medicine6 (2007): 1477-1483.
  17. Debas HT., et al. “Disease control priorities, (Volume 1): essential surgery: The World Bank (2015).
  18. Galukande M., et al. “Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries”. PLoS Medicine3 (2010).
  19. Jagiasi J., et al. “Delay in Surgical Management of Orthopedic Trauma Patients in an Urban Tertiary Care Hospital of India: A Crossectional Study.
  20. Joshi SC and Joshi R. “Doctor becomes a patient: a qualitative study of health care work place violence related perception among junior doctors working in a teaching hospital in India”. International Journal Of Community Medicine And Public Health 5 (2018): 1775-1786.
  21. Zhang L., et al. “Understanding the rise of Yinao in China: a commentary on the little known phenomenon of healthcare violence”. Nursing and Health Sciences2 (2017): 183-187.
  22. Zhang L., et al. “Workplace violence against nurses: A cross-sectional study”. International Journal of Nursing Studies 72 (2017): 8-14.
  23. Abdellah RF and Salama KM. “Prevalence and risk factors of workplace violence against health care workers in emergency department in Ismailia, Egypt”. The Pan African Medical Journal 1 (2017): 1-8.
  24. Abodunrin O., et al. “Prevalence and forms of violence against health care professionals in a South-Western city, Nigeria”. Sky Journal of Medicine and Medical Sciences 8 (2014): 67-72.
  25. Azodo C., et al. “Occupational violence against dental professionals in southern Nigeria”. African Health Sciences3 (2011).
  26. Udogwu F. “A case study on Violence against Nurses in Nigeria and recommendations in reducing the violence”. South American Journal of Nursing (2016).
  27. Seun-Fadipe CT., et al. “Workplace violence and risk for psychiatric morbidity among health workers in a tertiary health care setting in Nigeria: Prevalence and correlates”. Psychiatry Research 272 (2019): 730-736.
  28. Ogundipe KO., et al. “Violence in the emergency department: a multicentre survey of nurses’ perceptions in Nigeria”. Emergency Medicine Journal9 (2013): 758-762.
  29. Andaleeb SS. “Service quality perceptions and patient satisfaction: a study of hospitals in a developing country”. Social Science and Medicine9 (2001): 1359-1370.
  30. Lee MA and Yom Y-H. “A comparative study of patients’ and nurses’ perceptions of the quality of nursing services, satisfaction and intent to revisit the hospital: A questionnaire survey”. International Journal of Nursing Studies4 (2007): 545-555.
  31. Zineldin M. “The quality of health care and patient satisfaction”. International Journal of Health Care Quality Assurance (2006).
  32. Adamu H and Oche M. “Patient satisfaction with services at a general outpatient clinic of a tertiary hospital in Nigeria”. Journal of Advances in Medicine and Medical Research (2014): 2181-2202.
  33. Ogunfowokan O and Mora M. “Time, expectation and satisfaction: patients’ experience at National Hospital Abuja, Nigeria”. African Journal of Primary Health Care and Family Medicine1 (2012).
  34. Oluwadiya K., et al. “Patients’ satisfaction with emergency care and priorities for change in a university teaching hospital in Nigeria”. International Emergency Nursing4 (2010): 203-209.
  35. Ariba A., et al. “Patients' perception of quality of emergency care in a Nigerian teaching hospital: The influence of patient-provider interactions”. The Nigerian Postgraduate Medical Journal4 (2007): 296-301.
  36. Umar I., et al. “Patient waiting time in a tertiary health institution in Northern Nigeria”. Journal of Public Health and Epidemiology2 (2011): 78-82.
  37. Momodu D and Oseni T. “Medical Duty of Care: A Medico-Legal Analysis of Medical Negligence in Nigeria”. American International Journal of Contemporary Research1 (2019).
  38. Eze C., et al. “Legal issues facing radiographers in Nigeria”. British Journal of Healthcare Management4 (2012): 206-210.
  39. Iyioha IO. “Medical Negligence”. Comparative Health Law and Policy: Routledge (2016): 65-94.
  40. Bayero-Jimoh M., et al. “Physicians and wrong diagnosis of patients: An assessment of legal duties and liabilities in Nigeria”. Nnamdi Azikiwe University Journal of International Law and Jurisprudence 7 (2016): 90-100.
  41. Oguno P and Anigbogu I. “Medical Ethics And Medico-Legal Ethics: A Brief Anatomy Of Certain Salient Issues”. Chukwuemeka Odumegwu Ojukwu University Law Journal1 (2020).
  42. Gate H and Gate C. “Royal college of Obstetricians and Gynaecologists (2001).
  43. Livermore L and Cochrane R. “Decision to delivery interval: a retrospective study of 1,000 emergency caesarean sections”. Journal of Obstetrics and Gynaecology 4 (2006): 307-310.
  44. Clarke E. “Law and Ethics for Midwifery: Routledge (2015).
  45. Boehm FH. “Decision to incision: time to reconsider”. American Journal of Obstetrics and Gynecology 2 (2012): 97-98.
  46. Clarke JR., et al. “Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes”. Journal of Trauma and Acute Care Surgery 3 (2002): 420-425.
  47. Cadotte DW., et al. “The consequence of delayed neurosurgical care at Tikur Anbessa Hospital, Addis Ababa, Ethiopia”. World Neurosurgery 4 (2010): 270-275.
  48. Stevenson MD., et al. “Time from emergency department evaluation to operation and appendiceal perforation”. Pediatrics 6 (2017): e20160742.
  49. Chung C., et al. “Delays by patients, emergency physicians, and surgeons in the management of acute appendicitis: retrospective study”. Hong Kong Medical Journal 3 (2000): 254-259.
  50. Meyers N. “Patient-Specific Factors Associated With Surgical Delay In A Large Academic Hospital (2020).
  51. Landrum B., et al. “The impact of organizational stress and burnout on client engagement”. Journal of Substance Abuse Treatment 2 (2012): 222-230.
  52. Hall LH., et al. “Healthcare staff wellbeing, burnout, and patient safety: a systematic review”. PloS one 7 (2016): e0159015.
  53. Salen P and Norman K. “The Impact of Fatigue on Medical Error and Clinician Wellness: A Vignette-Based Discussion”. Vignettes in Patient Safety 2 (2018): 245.
  54. Qureshi HA., et al. “Burnout phenomenon in US plastic surgeons: risk factors and impact on quality of life”. Plastic and Reconstructive Surgery2 (2015): 619-626.
  55. Balch CM., et al. “Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences”. Archives of Surgery4 (2009): 371-376.
  56. Yakasai IA. “Decision-To-Delivery Interval For Emergency Caesarean Section And Feto-Maternal Outcome At Aminu Kano Teaching Hospital, Kano, Nigeria”. Faculty of Obstetrics and Gynaecology (2011).
  57. Ifesanya AO., et al. “Orthopaedic surgical treatment delays at a tertiary hospital in sub Saharan Africa: Communication gaps and implications for clinical outcomes”. Nigerian Medical Journal: Journal of the Nigeria Medical Association6 (2013): 420.
  58. Table BR. “2019 Conference on Global Surgery”. Canadian Journal of Surgery 5 (2019): 1.
  59. Tabiri S., et al. “Barriers to timely presentation of patients with surgical conditions at Tamale Teaching Hospital in Northern Ghana”. World Journal of Surgery2 (2019): 346-352.
  60. Mpirimbanyi C., et al. “Defining the three delays in referral of surgical emergencies from district hospitals to university teaching hospital of Kigali, Rwanda”. World Journal of Surgery8 (2019): 1871-1879.
  61. Kamotho D., et al. “Decision to incision interval for emergency caesarean section and postoperative outcomes in a resource limited rural Kenyan public hospital”. International Journal of Reproduction, Contraception, Obstetrics and Gynecology7 (2018): 2574.
  62. Luboga S., et al. “Increasing access to surgical services in sub-saharan Africa: priorities for national and international agencies recommended by the Bellagio Essential Surgery Group”. PLoS Medicine12 (2009): 200.
Citation: Olubusola T Alagbe-Briggs and Rex Friday Ogoronte A Ijah. “Decision to Incision for Surgical Emergencies: The Practice and Challenges in a Low-Income Setting”. EC Emergency Medicine and Critical Care 5.5 (2021): 47-60.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


October Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the October issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before November 01, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk