Table 5 Key findings and recommendations from needs analyses in Timor – Leste and Kiribati
Country and Context | Key findings | Priority Recommendations |
|---|---|---|
Timor-Leste (2009) (national referral hospital) • Post-conflict • Many different service providers • Cuban doctor training program • New ED building • Limited understanding of EC • Strong sense of unity • Change occurs through mentoring and modelling | Lack of triage impacting on quality of care Entrance overcrowding and assessment area bottleneck Poor information management and communication across language/culture Very limited staff training, precarious leadership, sustainability challenges Quality of care limitations Insufficient use of space | Substantial investment in local staff • Identify potential leaders • Provision of ED career structure • Long and short term training • Provide mentors • Short and long term technical assistance Development and implementation of a triage system Clinical guidelines and regular audits Improved formal communication; handover, referral, documentation Basic equipment provision ED re-design suggestions |
Kiribati (2011) (national referral hospital) • Small atoll nation • Very close community • Strong nurse training and nurse culture • Few doctors, some Cuban medical training • Old ED building • Change occurs through senior leadership and consensus collaboration | Inadequate nurse numbers and insufficient EC training Absent medical leadership Very poor environment; not fit for purpose, limited renovation potential, no amenity No triage system Overcrowding and bottlenecks Minimal clinical guidelines or quality standards Minimal equipment and information management resources | Short term • Build ED nursing knowledge and leadership • Minor renovation and re-use of existing space, basic amenity repairs • Development and implementation of a simple triage system • Patient flow and clinical guideline working groups Longer term • Invest in medical ED leadership • Improve IT and data management systems • Source funding for more extensive ED renovation |