Grant: Travel Awards - Institute Community Support

Healthcare systems globally fail to optimally use evidence to improve clinical care and patient outcomes. By providing a step by step approach to patient evaluation and management, evidence based clinical algorithms (EBCA), are useful tools to facilitate uptake of evidence into routine clinical care. However, their impact on process and outcomes of care varies considerably across practice settings and healthcare providers, highlighting the importance of tailoring both EBCAs and the approach to their implementation to the healthcare context in which they will be used. The Tikur Anbessa Hospital (TASH) is the largest public teaching hospital in Addis Ababa and a leader in the development of emergency medicine in Ethiopia. Clinicians and managers in the TASH emergency department (ED) have identified a need for context appropriate EBCAs to improve uptake of evidence into routine clinical practice to improve patient outcomes in the TASH-ED. In order to understand barriers and facilitators to use of EBCAs in the TASH-ED we conducted interviews with TASH-ED clinical and support staff, observed the process of clinical care in the TASH-ED, and reviewed ED documentation forms and procedures. We found that most participants had heard of EBCAs but had little experience using them, mainly due to the poor fit of EBCAs developed in high income countries with the resource constraints of the TASH-ED. All participants felt that EBCAs could improve patient outcomes by standardizing care and increasing evidence based practice particularly for common serious illnesses such as trauma, sepsis, heart failure and diabetic emergencies. Participants also noted that while ED staff would support use of EBCAs, this approach to practice would be less accepted by other clinical groups, and felt that involvement of clinicians from other departments during development was essential to successful implementation of EBCAs. Our findings will be used to develop and evaluate EBCAs for the TASH-ED.