Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda
Introduction: Prompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobil...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
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| Series: | African Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211419X2300037X |
| _version_ | 1797399144092925952 |
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| author | Mediatrice Niyonsaba Menelas Nkeshimana Jean Marie Uwitonze Justine Davies Rebecca Maine Jeanne D'Arc Nyinawankusi McKenna Hunt Rob Rickard Sudha Jayaraman Melissa H. Watt |
| author_facet | Mediatrice Niyonsaba Menelas Nkeshimana Jean Marie Uwitonze Justine Davies Rebecca Maine Jeanne D'Arc Nyinawankusi McKenna Hunt Rob Rickard Sudha Jayaraman Melissa H. Watt |
| author_sort | Mediatrice Niyonsaba |
| collection | DOAJ |
| description | Introduction: Prompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobile health (mHealth) tool to address these challenges. Methods: In-depth interviews were conducted with 21 individuals representing four stakeholder groups: EMS dispatch staff, ambulance staff, hospital staff, and policymakers. A semi-structured interview guide explored participants’ perspectives on all aspects of the pre-hospital emergency care continuum, from receiving a call at dispatch to hospital handover. Participants were asked how the current system could be improved, and the potential utility of an mHealth tool to address existing challenges. Interviews were audio-recorded, and transcripts were thematically analyzed using NVivo. Results: Stakeholders identified factors that compromise the efficiency and quality of care across the prehospital emergency care continuum: triage at dispatch, dispatching the ambulance, locating the emergency, coordinating patient care at scene, preparing the receiving hospital, and patient handover to the hospital. They identified four areas where an mHealth tool could improve care: efficient location of the emergency, streamline communication for decision making, documentation with real-time communication, and routine data for quality improvement. While stakeholders identified advantages of an mHealth tool, they also mentioned challenges that would need to be addressed, namely: limited internet bandwidth, capacity to maintain and update software, and risks of data security breaches that could lead to stolen or lost data. Conclusion: Despite the success of Rwanda's EMS system, this study highlights factors across the care continuum that could compromise quality and efficiency of prehospital emergency care. Mobile health tools hold great promise to address these challenges, but contextual issues need to be considered to ensure sustainability of use. |
| first_indexed | 2024-03-09T01:35:13Z |
| format | Article |
| id | doaj.art-748926f94c54434995a6aa6013701597 |
| institution | Directory Open Access Journal |
| issn | 2211-419X |
| language | English |
| last_indexed | 2024-03-09T01:35:13Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | African Journal of Emergency Medicine |
| spelling | doaj.art-748926f94c54434995a6aa60137015972023-12-09T06:05:48ZengElsevierAfrican Journal of Emergency Medicine2211-419X2023-12-01134250257Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in RwandaMediatrice Niyonsaba0Menelas Nkeshimana1Jean Marie Uwitonze2Justine Davies3Rebecca Maine4Jeanne D'Arc Nyinawankusi5McKenna Hunt6Rob Rickard7Sudha Jayaraman8Melissa H. Watt9Rwanda Biomedical Center, Division of Emergency Medical Services, Rwanda; Corresponding author.University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali), RwandaRwanda Biomedical Center, Division of Emergency Medical Services, RwandaUniversity of Birmingham, Institute of Applied Health Research, United Kingdom; Stellenbosch University, Centre for Global Surgery, Department of Global Health, South Africa; University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, South AfricaUniversity of Washington, Department of Surgery, United StatesRwanda Biomedical Center, Division of Emergency Medical Services, RwandaUniversity of Utah, Honors College, United StatesRwanda Build Program, Common World Inc., RwandaUniversity of Utah, Department of Surgery, United StatesUniversity of Utah, Department of Population Health Sciences, United StatesIntroduction: Prompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobile health (mHealth) tool to address these challenges. Methods: In-depth interviews were conducted with 21 individuals representing four stakeholder groups: EMS dispatch staff, ambulance staff, hospital staff, and policymakers. A semi-structured interview guide explored participants’ perspectives on all aspects of the pre-hospital emergency care continuum, from receiving a call at dispatch to hospital handover. Participants were asked how the current system could be improved, and the potential utility of an mHealth tool to address existing challenges. Interviews were audio-recorded, and transcripts were thematically analyzed using NVivo. Results: Stakeholders identified factors that compromise the efficiency and quality of care across the prehospital emergency care continuum: triage at dispatch, dispatching the ambulance, locating the emergency, coordinating patient care at scene, preparing the receiving hospital, and patient handover to the hospital. They identified four areas where an mHealth tool could improve care: efficient location of the emergency, streamline communication for decision making, documentation with real-time communication, and routine data for quality improvement. While stakeholders identified advantages of an mHealth tool, they also mentioned challenges that would need to be addressed, namely: limited internet bandwidth, capacity to maintain and update software, and risks of data security breaches that could lead to stolen or lost data. Conclusion: Despite the success of Rwanda's EMS system, this study highlights factors across the care continuum that could compromise quality and efficiency of prehospital emergency care. Mobile health tools hold great promise to address these challenges, but contextual issues need to be considered to ensure sustainability of use.http://www.sciencedirect.com/science/article/pii/S2211419X2300037XRwandaEmergency medicinePre-hospital emergency careQualitativeAmbulance |
| spellingShingle | Mediatrice Niyonsaba Menelas Nkeshimana Jean Marie Uwitonze Justine Davies Rebecca Maine Jeanne D'Arc Nyinawankusi McKenna Hunt Rob Rickard Sudha Jayaraman Melissa H. Watt Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda African Journal of Emergency Medicine Rwanda Emergency medicine Pre-hospital emergency care Qualitative Ambulance |
| title | Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda |
| title_full | Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda |
| title_fullStr | Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda |
| title_full_unstemmed | Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda |
| title_short | Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda |
| title_sort | challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mhealth platform qualitative study in rwanda |
| topic | Rwanda Emergency medicine Pre-hospital emergency care Qualitative Ambulance |
| url | http://www.sciencedirect.com/science/article/pii/S2211419X2300037X |
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