Level of Emergency Preparedness and Associated Barriers at the Accident and Emergency Ward of a LMIC Hospital: A Cross-Sectional Assessment Using the WHO HEAT Tool

Abstract

Background: Emergency preparedness is a challenge for hospital emergency departments (EDs). In the USA, over 68% of 983 EDs were not emergency prepared, while in Ghana, one hospital’s emergency preparedness level was only 57.4%. At the health facility level, several barriers to emergency preparedness have been reported, including poor access to medical supplies, medications, and equipment; deficits in medical training; and the absence of formal clinical management protocols. Methodology: A cross-sectional study was conducted at the Accident and Emergency (A&E) Ward of Mbarara Regional Referral Hospital (MRRH). Data was collected using the modified WHO HEAT checklist, completed by three (3) key hospital informants, who were preferred for their key insights over a large sample of general staff. Data fell into 11 variables with items in each variable scored between 0 and 2, then the total scores generated percentages. By univariate analysis, the level of emergency preparedness and the associated barriers at the A&E Ward of MRRH were determined. Results: The overall emergency preparedness score at the A&E ward of MRRH was 62.6%, with the human resources category under ED capacity scoring the lowest (37.5%), while the consulting services category under ED resources scored the highest (71.4%). The two most common associated barriers to emergency preparedness in the A&E were medicine stockouts (35.0%) and missing emergency equipment (29.2%), while the least reported barriers were user fees (2.2%), and opening hours (0.7%). Conclusion: According to this study, the level of emergency preparedness in the A&E ward of MRRH was weak, with low level of human resource, and weak quality improvement checks the most contributing factors. The highest reported barriers to strong emergency preparedness in the A&E ward of MRRH were medication stockouts and the absence of emergency equipment.