Dataset Information

Emergency medicine physician supervision and mortality among patients receiving care from non-physician clinicians in a task-sharing model of emergency care in rural Uganda: a retrospective analysis of a single-centre training programme.

ABSTRACT:

Objectives

To assess the association between emergency medicine physician supervision and 3-day mortality for patients receiving care from non-physician clinicians in a task-sharing model of emergency care in rural Uganda.

Design

Retrospective cohort analysis with multivariable logistic regression.

Setting

Single rural Ugandan emergency unit.

Participants

All patients presenting for care from 2009 to 2019.

Interventions

Three cohorts of patients receiving care from non-physician clinicians had three different levels of physician supervision: 'Direct Supervision' (2009-2010) emergency medicine physicians directly supervised all care; 'Indirect Supervision' (2010-2015) emergency medicine physicians were consulted as needed; 'Independent Care' (2015-2019) no emergency medicine physician supervision.

Primary outcome measure

Three-day mortality.

Results

38 033 ED visits met inclusion criteria. Overall mortality decreased significantly across supervision cohorts ('Direct' 3.8%, 'Indirect' 3.3%, 'Independent' 2.6%, p<0.001), but so too did the rates of patients who presented with ≥3 abnormal vitals ('Direct' 32%, 'Indirect' 19%, 'Independent' 13%, p<0.001). After controlling for vital sign abnormalities, 'Direct' and 'Indirect' supervision were both significantly associated with reduced OR for mortality ('Direct': 0.57 (0.37 to 0.90), 'Indirect': 0.71 (0.55 to 0.92)) when compared with 'Independent Care'. Sensitivity analysis showed that this mortality benefit was significant for the minority of patients (17.2%) with ≥3 abnormal vitals ('Direct': 0.44 (0.22 to 0.85), 'Indirect': 0.60 (0.41 to 0.88)), but not for the majority (82.8%) with two or fewer abnormal vitals ('Direct': 0.81 (0.44 to 1.49), 'Indirect': 0.82 (0.58 to 1.16)).

Conclusions

Emergency medicine physician supervision of emergency care non-physician clinicians is independently associated with reduced overall mortality. This benefit appears restricted to the highest risk patients based on abnormal vitals. With over 80% of patients having equivalent mortality outcomes with independent non-physician clinician emergency care, a synergistic model providing variable levels of emergency medicine physician supervision or care based on patient acuity could safely address staffing shortages.

SUBMITTER: Rice B

PROVIDER: S-EPMC9244677 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Emergency medicine physician supervision and mortality among patients receiving care from non-physician clinicians in a task-sharing model of emergency care in rural Uganda: a retrospective analysis of a single-centre training programme.

Rice Brian B Pickering Ashley A Laurence Colleen C Kizito Prisca Mary PM Leff Rebecca R Kisingiri Steven Jonathan SJ Ndyamwijuka Charles C Nakato Serena S Adriko Lema Felix LF Bisanzo Mark M

BMJ open 20220629 6

<h4>Objectives</h4>To assess the association between emergency medicine physician supervision and 3-day mortality for patients receiving care from non-physician clinicians in a task-sharing model of emergency care in rural Uganda.<h4>Design</h4>Retrospective cohort analysis with multivariable logistic regression.<h4>Setting</h4>Single rural Ugandan emergency unit.<h4>Participants</h4>All patients presenting for care from 2009 to 2019.<h4>Interventions</h4>Three cohorts of patients receiving care ...[more]

PMID: 35768107

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Dataset Information

Emergency medicine physician supervision and mortality among patients receiving care from non-physician clinicians in a task-sharing model of emergency care in rural Uganda: a retrospective analysis of a single-centre training programme.

Objectives

Design

Setting

Participants

Interventions

Primary outcome measure

Results

Conclusions

Publications

Emergency medicine physician supervision and mortality among patients receiving care from non-physician clinicians in a task-sharing model of emergency care in rural Uganda: a retrospective analysis of a single-centre training programme.

Similar Datasets

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