The primary aim of this project is to improve pediatric emergency care throughout Belize. We have created a two-year Pediatric Emergency Medicine (PEM) curriculum for non-specialty trained medical providers who provide care for pediatric emergencies in the clinic, emergency, and hospital settings. Our training is based at Karl Heusner Memorial Hospital (KHMHA), the largest government referral hospital in Belize, and includes medical providers from around the country. While many countries have implemented pediatric or emergency medicine curricula for physicians, to our knowledge, there are no existing PEM curricula designed to be implemented over the course of two years to a multi-disciplinary team. Our aim is to improve the quality of care of pediatric emergencies nationwide, including overall mortality and reducing hospital admission, transfer and complication rates.
Early recognition and stabilization of acutely ill and injured infants and children improves outcomes. However, many healthcare facilities in resource-limited countries are ill-equipped to recognize and stabilize emergently ill children, resulting in delays treatment. Evidence suggests that interventions including triage training, educational initiatives, and use of clinical practice guidelines can improve care.
In Belize, the 2012 infant and under 5 mortality rates were 1.6% and 1.8%, respectively. Although Belize has made great strides in reducing these rates, critical gaps remain. One of the challenges identified in the recent United Nation’s Development Programme’s Millennium Development Goals Report and Post 2015 Agenda for Belize is the continuing need for capacity building in the health care system, including increasing the quality of health care providers. KHMHA is a government-sponsored hospital in Belize City that serves as both a district hospital and the national referral center. Emergency care is provided through the Accident & Emergency (A&E) Department. The annual volume is ~25,000 visits/year. Currently, there are no standardized evidence-based clinical guidelines or formal curriculum for providers, and pediatric emergency care varies depending on the individual provider’s level of training and skill set. The hospital has identified a need for and requested external training on the initial triage of pediatric patients and the management of pediatric emergencies for both physicians and nurses. In addition to hospital staff, we are also training medical providers from around the country as coordinated by the Ministry of Health.
Our aim is to improve the quality of care of pediatric emergencies nationwide, including overall mortality and reducing hospital admission, transfer and complication rates. We will measure this by assessing overall pediatric mortality rates at KHMHA and transfer and admission rates. In addition, key clinical indicators for specific disease conditions (e.g. time to antibiotics in pneumonia, time to steroids in asthma, fluid resuscitation in acute gastroenteritis) will be measured to assess for the clinical impact of trainings. Going forward, this curriculum can be modified and applied to other low and middle income countries to improve pediatric emergency care.
We trained over 15 healthcare providers at KHMHA, increasing healthcare capacity in-country and their ability to deliver high-quality pediatric emergency care.