RT Journal Article
SR Electronic
T1 Standard operating procedures improve acute neurologic care in a sub-Saharan African setting
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 144
OP 152
DO 10.1212/WNL.0000000000004080
VO 89
IS 2
A1 Lamin E.S. Jaiteh
A1 Stefan A. Helwig
A1 Abubacarr Jagne
A1 Andreas Ragoschke-Schumm
A1 Catherine Sarr
A1 Silke Walter
A1 Martin Lesmeister
A1 Matthias Manitz
A1 Sebastian Blaß
A1 Sarah Weis
A1 Verena Schlund
A1 Neneh Bah
A1 Jil Kauffmann
A1 Mathias Fousse
A1 Sabina Kangankan
A1 Asmell Ramos Cabrera
A1 Kai Kronfeld
A1 Christian Ruckes
A1 Yang Liu
A1 Ousman Nyan
A1 Klaus Fassbender
YR 2017
UL http://n.neurology.org/content/89/2/144.abstract
AB Objective: Quality of neurologic emergency management in an under-resourced country may be improved by standard operating procedures (SOPs).Methods: Neurologic SOPs were implemented in a large urban (Banjul) and a small rural (Brikama) hospital in the Gambia. As quality indicators of neurologic emergency management, performance of key procedures was assessed at baseline and in the first and second implementation years.Results: At Banjul, 100 patients of the first-year intervention group exhibited higher rates of general procedures of emergency management than 105 control patients, such as neurologic examination (99.0% vs 91.4%; p < 0.05) and assessments of respiratory rate (98.0% vs 81.9%, p < 0.001), temperature (60.0% vs 36.2%; p < 0.001), and glucose levels (73.0% vs 58.1%; p < 0.05), in addition to written directives by physicians (96.0% vs 88.6%, p < 0.05), whereas assessments of other vital signs remained unchanged. In stroke patients, rates of stroke-related procedures increased: early CT scanning (24.3% vs 9.9%; p < 0.05), blood count (73.0% vs 49.3%; p < 0.01), renal and liver function tests (50.0% vs 5.6%, p < 0.001), aspirin prophylaxis (47.3% vs 9.9%; p < 0.001), and physiotherapy (41.9% vs 4.2%; p < 0.001). Most effects persisted until the second-year evaluation. SOP implementation was similarly feasible and beneficial at the Brikama hospital. However, outcomes did not significantly differ in the hospitals.Conclusions: Implementing SOPs is a realistic, low-cost option for improving process quality of neurologic emergency management in under-resourced settings.Classification of evidence: This study provides Class IV evidence that, for patients with suspected neurologic emergencies in sub-Saharan Africa, neurologic SOPs increase the rate of performance of guideline-recommended procedures.CBC=complete blood count; GOS=Glasgow Outcome Scale; mRS=modified Rankin Scale; SOP=standard operating procedure