Neurologic emergency management in resource-challenged settings: Can standard operating procedures work and improve outcomes?
Jerome H.Chin, Adjunct Professor, Department of Neurology, NYU Langone Medical Centerchinj@asapp.org
Submitted July 06, 2017
The study by Jaiteh et al. highlighted the potential value of standard operating procedures (SOPs) for neurologic emergency management in the Gambia, [1] a low-income country in sub-Saharan Africa (SSA).
Although this study increases in the rates of performance of most SOPs in the first and second intervention years compared to baseline, [1] these improvements occurred in an experimental study setting which likely motivated health workers to outperform. Whether similar performance can be expected and sustained in a real-world setting is uncertain. Hospitals in resource-limited countries face numerous challenges including under-staffing, health worker strikes, medication stock-outs, and equipment malfunctions. In many low- and middle-income countries, out-of-pocket payments are the primary source of funding for health care, delaying or excluding attainment of necessary tests. [2] For example, a brain CT costs approximately $60 USD out-of-pocket for patients admitted to the national referral hospital of Uganda [3]; a price not affordable for many patients.
Clinical outcomes did not significantly change as a result of the SOPs intervention. [1] Improving outcomes from stroke, the most common diagnosis, may require additional SOPs for post-emergency management, addressing procedures and therapy for blood pressure, intracranial pressure, and prevention of stroke complications (ie, deep venous thrombosis and aspiration pneumonia).
1. Jaiteh LES, Helwig SA, Jagne A, et al. Standard operating procedures improve acute neurologic care in a sub-Saharan African setting. Neurology Epub 2017 Jun 9.
2. World health statistics 2017: monitoring health for the SDGs (Sustainable Development Goals). Geneva: World Health Organization; 2017. Available at:
http://www.who.int/gho/publications/world_health_statistics/2017/en/. Accessed June 26, 2017.
3. Chin JH. Stroke in sub-Saharan Africa: an urgent call for prevention. Neurology 2012;78:1007-1008.
For disclosures, please contact the editorial office at journal@neurology.org.
The study by Jaiteh et al. highlighted the potential value of standard operating procedures (SOPs) for neurologic emergency management in the Gambia, [1] a low-income country in sub-Saharan Africa (SSA).
Although this study increases in the rates of performance of most SOPs in the first and second intervention years compared to baseline, [1] these improvements occurred in an experimental study setting which likely motivated health workers to outperform. Whether similar performance can be expected and sustained in a real-world setting is uncertain. Hospitals in resource-limited countries face numerous challenges including under-staffing, health worker strikes, medication stock-outs, and equipment malfunctions. In many low- and middle-income countries, out-of-pocket payments are the primary source of funding for health care, delaying or excluding attainment of necessary tests. [2] For example, a brain CT costs approximately $60 USD out-of-pocket for patients admitted to the national referral hospital of Uganda [3]; a price not affordable for many patients.
Clinical outcomes did not significantly change as a result of the SOPs intervention. [1] Improving outcomes from stroke, the most common diagnosis, may require additional SOPs for post-emergency management, addressing procedures and therapy for blood pressure, intracranial pressure, and prevention of stroke complications (ie, deep venous thrombosis and aspiration pneumonia).
1. Jaiteh LES, Helwig SA, Jagne A, et al. Standard operating procedures improve acute neurologic care in a sub-Saharan African setting. Neurology Epub 2017 Jun 9.
2. World health statistics 2017: monitoring health for the SDGs (Sustainable Development Goals). Geneva: World Health Organization; 2017. Available at: http://www.who.int/gho/publications/world_health_statistics/2017/en/. Accessed June 26, 2017.
3. Chin JH. Stroke in sub-Saharan Africa: an urgent call for prevention. Neurology 2012;78:1007-1008.
For disclosures, please contact the editorial office at journal@neurology.org.