Access delays to essential surgical care using the Three Delays Framework and Bellwether procedures at Timor Leste's national referral hospital

Bagguley, Dominic, Fordyce, Andrew, Guterres, Jose, Soares, Alito, Valadares, Edgar, Guest, Glenn Douglas and Watters, David 2019, Access delays to essential surgical care using the Three Delays Framework and Bellwether procedures at Timor Leste's national referral hospital, BMJ Open, vol. 9, no. 8, pp. 1-5, doi: 10.1136/bmjopen-2019-029812.

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Title Access delays to essential surgical care using the Three Delays Framework and Bellwether procedures at Timor Leste's national referral hospital
Author(s) Bagguley, Dominic
Fordyce, Andrew
Guterres, Jose
Soares, Alito
Valadares, Edgar
Guest, Glenn Douglas
Watters, DavidORCID iD for Watters, David orcid.org/0000-0002-5742-8417
Journal name BMJ Open
Volume number 9
Issue number 8
Article ID e029812
Start page 1
End page 5
Total pages 5
Publisher BMJ
Place of publication London, Eng.
Publication date 2019
ISSN 2044-6055
Keyword(s) access to surgical care
acute abdominal pain
caesarean section
laparotomy
open fracture
patient journey
Summary Objectives Our objectives were to characterise the nature and extent of delay times to essential surgical care in a developing nation by measuring the actual stages of delay for patients receiving Bellwether procedures. Setting The study was conducted at Timor Leste's national referral hospital in Dili, the country's capital. Participants All patients requiring a Bellwether procedure over a 2-month period were included in the study. Participants whose procedure was undertaken more than 24 hours from initial hospital presentation were excluded. Primary and secondary outcome measures Data pertaining to the patient journey from onset of symptoms to emergency procedure was collected by interview of patients, their treating surgeons or anaesthetists and the medical records. Timelines were then calculated against the Three Delays Framework. Results Fifty-six patients were entered into the study. Their mean delay from symptom onset to entering the anaesthesia bay for a procedure was 32.3 hours (+/-11.6). The second delay (4.1+/-2.5 hours) was significantly less than the first (20.9+/-11.5 hours; p<0.005) and third delays (7.2+/-1.2 hours; p<0.05). Additionally, patients with acute abdominal pain (of which 18/20 ultimately had open appendicectomy and two emergency laparotomies) had a delay time of 53.3 hours (+/-21.3), significantly more than that for emergency caesarean (22.9+/-18.6 hours; p<0.05) or management of an open long-bone fracture (15.5+/-5.56 hours; p<0.05). Conclusions Substantial delays were observed for all three stages and each Bellwether procedure. This study methodology could be used to measure access and the three delays to emergency surgical care in low/middle-income countries, although the actual reasons for delay may vary between regions and countries and would require a qualitative study.
Language eng
DOI 10.1136/bmjopen-2019-029812
Indigenous content off
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2019, The Author(s)
Persistent URL http://hdl.handle.net/10536/DRO/DU:30129663

Document type: Journal Article
Collections: Faculty of Health
School of Medicine
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