Joseph Musowoya (1), Carlos Varela (2), Alex Makupe (1), Jacob S Dreyer (3).
Dept of Surgery, Ndola Central Hospital, Zambia (1); Dept of Surgery, Kamuzu Central
Hospital, Lilongwe, Malawi (2); Dept of Surgery, NHS Dumfries & Galloway, UK (3)
Background: Surgical trainees in Africa are at the forefront of emergency surgical services, often
having to make rapid decisions in a number of critically ill patients at the same time. In
the COSECSA/ASGBI critical care (CC) course they are taught structured thinking
processes in patient assessment, decision making and treatment. In the CC course they
learn a patient assessment checklist to help guide such structured thinking.
Aim:To assess whether use of the checklist in critical illness will guide structured patient
assessment, decisionmaking, patient management, communication and handover.
Methods: The Patient Assessment Checklist had been developed from principles taught in a CC
course developed for trainees, surgeons and health/clinical officers in East/Central
Africa, and is closely related to principles taught in similar courses in the UK. The
checklist was distributed in surgical admission units in hospitals in Ndola, Lusaka and
Lilongwe. A single A4 feedback page was distributed with the checklist with opportunity
to check boxes on the value of the checklist, to indicate what the patient's main problem
was, and to write a short vignette as free text. The completed feedback forms were
analysed qualitatively by the senior author.
Results: Feedback forms were received from Ndola Central Hospital and Kamuzu Central
Hospital, Lilongwe. In almost all patients participants recorded that the checklist
improved structured patient assessment and management. It was of specific value in
managing patients who were dying or in pain, with confusion, hypotension, hypoxia and
sepsis. Qualitative analysis of vignettes supported these results.
Conclusion: The patient assessment checklist facilitates critically ill patient management through
providing structure to clinical assessment, rapid decisionmaking and treatment,
communication and handover.