Investigator(s)
| WHO Technical Officer |
Paban Kumar Ghimire World Health Organization, Country Office for Nepal Paban Kumar Ghimire 
|
| Principal Investigator |
Samir Kumar Adhikari Ministry of Health and Poulation, Kathmandu, Nepal Samir Kumar Adhikari
|
Title(s) and abstract
| Scientific title | GoN-WHO Emergency Care System Strengthening Initiative at seven provincial hospital sites in the Federal Democratic Republic of Nepal |
| Public title | GoN-WHO Emergency Care System Strengthening Initiative at seven provincial hospital sites in the Federal Democratic Republic of Nepal |
| Background | The WHO Global Emergency and Trauma Care Initiative (GETI) activities include building consensus-based action priorities through the Emergency Care System Assessment (ECSA), implementation of the WHO ECS toolkit, and Monitoring & Evaluation of the impact of the implementation. Nepal has been nominated as a core country for WHO GETI implementation and for receipt of focused WHO support. In 2022 and 2023, the WHO will implement the emergency care intervention package in provincial hospitals across Nepal. As part of an ongoing quality improvement initiative, both pre and the post-intervention mortality and process interventions will be recorded. A cost-effective analysis will also be performed. The GETI activities will be implemented through the ECS strengthening project with the lead facilitation of the HEOC in collaboration with the curative service division of the Department of Health Service, MoHP, Government of Nepal. |
| Objectives | To assess the WHO emergency care tools (including the WHO/ICRC Basic Emergency Care clinical training, WHO emergency care checklists and WHO/ICRC/MSF interagency triage tool) and measure the impact of the implementation on patient mortality. The specific objectives are: • Collect baseline mortality, process outcome indicators and cost-effectiveness data at identified implementation sites using the WHO GETI emergency care indicators. • Evaluate intervention implementation outcomes, including education assessments, post-implementation surveys and focus groups • Compare pre and post-implementation data on mortality, process outcomes and cost-effectiveness. • Evaluate ongoing adoption, uptake and fidelity of clinical process changes and clinical care improvement |
| Study Methods | Study Design: The overall study design is a hybrid type 2, pragmatic, implementation-effectiveness study using a quasi-experimental approach. The rationale and explanation for selecting this design are as follows: Hybrid studies allow researchers to study the health outcomes from a clinical intervention while simultaneously studying the implementation processes of the intervention itself. This helps to accelerate the translation of evidence from research into clinical practice. A type 2 hybrid study places equal emphasis on clinical outcomes and implementation processes. A pragmatic design implies that we attempt to conduct the implementation using the most ‘real-life’ situations and circumstances as possible, and we create less of an artificial or experimental setting for implementation. Findings from pragmatic studies provides valuable information about how the evidence-based intervention may perform if replicated or transposed to other similar settings. Quasi-experimental approach refers to the design of the clinical portion of the study. There is no subject randomization in quasi-experimental studies, and the intervention is pre-assigned. In our proposed research, it will be impossible to randomize at the provider level (given provider inter-mixing and personal interactions at each participating hospital) and impossible to randomize at the patient level. |
| Expected outcomes and use of results | Strengthening the Emergency Care Services for acute illness and injury is more critical. In order to implement context-relevant effective emergency care interventions for Nepal, we must better understand emergency presentations and acute disease patterns along with the evidence. Measuring mortality and process outcomes before and after the implementation of the EC toolkit will the stakeholders to assess the impact of the intervention and further develop a strategic plan for strengthening Nepal’s ECS. |
| Keywords | ECS, Toolkit, emergency |
Research Details
| Student research | No |
| Start Date | 01-Feb-2022 |
| End Date | 31-May-2023 |
| Key Implementing Institution | Ministry of health and Population, Nepal |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Health Systems Research |
| Research field(s) | |
| Involves human subjects | Yes |
| Intervention Evaluation Research | |
| Data Collection | Secondary data |
| Proposal reviewed by other Committee | No |