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Table 5 Key findings and recommendations from needs analyses in Timor – Leste and Kiribati

From: A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region

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