AMBO UNIVERSITY REFERRAL HOSPITAL

EMERGENCY CARE SERVICE ASSESSMENT LEVELLING

October, 2023
Ambo, Ethiopia
 EMERGENCY CARE SERVICE ASSESSMENT LEVELLING
Goal: Reduce mortality, morbidity and disability due to emergency cases by ensuring provision of emergency service in all
facilities based on set agreed level of care.

Objective of the To evaluate the structure and key functions of an emergency unit.
assessment To determine the level of emergency care service and minimum requirements for the level of the unit.
To identify gaps and target interventions at individual level of the facility
Note: Source of information could be Key informants interview and/or Visual Observation
Take necessary intervention for identified gaps
Key informants that might provide important information for this assessment includes Interview and Visual Observation method
of data collection.

I. Emergency unit arrangement for advanced level emergency service

II. Resource requirements for advanced level emergency service
 Facility characteristics
Date 24/02/2016
Country Ethiopia
Name of facility Ambo University Referral Hospital
Level of the hospital Advanced
Address of facility Oromia, West Shoa, Ambo
Catchment population 3.5 million

Assessment Team
S.N Name of Assessor Responsibility Mobile Email
1 Firomsa Fita CG & QIUD +251920052377 [email protected]
2 Iranfachisa Gurmu CG& QIU officer +251922966830 [email protected]

3 Lalisa Masarat EOPD team leader +251928659474

Lists of contacted people for interview and discussion

S.N Name of interviewee Responsibility Mobile

1 Dr. Ararsa Horesa CCD +251912716063
2 Dr. Tamirat Gutema EM. & ICU director +251911986334
3 Dr. Megersa Negasa Internal medicine department head +251911176545
 RESOURCE REQUIREMENT FOR REFERRAL HOSPITAL EMERGENCY UNIT
Method of data collection: Interview and Visual Observation
Facility Name Ambo University Referral Hospital

Audit topic Emergency Department service and structural audit for Comprehensive
Specialized Hospital
Objective To evaluate the structure and key functions of an emergency unit
Period of audit 19/02/2016-24/02/2016
Exclusion criteria (where applicable) NA

Scoring Criteria:
1. If all are completed give ‘1’ if not give ‘0’
2. For Yes/No questions Yes=1, No=0
EMERGENCY UNIT ARRENGEMENT AND SERVICE OF Comprehensive Specialized HOSPITAL (15%) (CF 0.238)
Measurement Criteria Remark
Does the facility provide emergency service for 24 hours a day and 7 days a week? 1
Is the emergency unit led by a designated emergency director or case team leader? 1
Is the ER clearly labeled and visible? (Red background with White labels) 1
Is the emergency room situated at the ground floor of a building? 1
Is the floor covering of the emergency unit a non-slippery surface, impermeable to water, easy to clean; acoustic 1
properties that reduce sound transmission and shock absorption to facilitate movement of beds?
Does the triage area have a clear vision to both the waiting room and the ambulance entrance? 1
Are all doors through which patient pass of sufficient size to accommodate a full hospital bed with attached 1
intravenous flasks and traction apparatus with ease?
Is ambulance parking area near to the Emergency Room? 1
Does the ambulance parking area has at least 2 ambulance parking spots and should be close to triage and 1
resuscitation area?
Is there a walk-in entrance discrete from the ambulance entrance? 1
Is there an air ambulance drop off area with easy access to the emergency department? 1
Are there electrical sockets and hand washing facilities? 1
Is there an open waiting area for patients that can accommodate 20 relatives/escorts and should be clearly visible 1
from the triage and reception areas?
Is the waiting area located within an enclosed space with TV and other recreational modalities? 0
Does the ED assign patient assistant (receptionist) at emergency gate area to receive, support and direct 1
patients?
1. Triage area 1
2. Resuscitation area 1
3. Procedure area 1

4. Examination area 1
Does the EU have a separate 5. Short stay area 1
6. Waiting area 1
7. Isolation area 1

8. Decontamination area 1
9. Dirty utility/disposal room. 1
Is there disaster equipment storage area with size depending on the anticipated disaster and the facility’s role? 1
Is There an acute treatment area with short stay beds and color coded zones depending on the acuity of patient 1
condition (RED, ORANGE, and YELLOW/GREEN ZONES)?
Is there dedicated work station with in the ED with office furniture? 1
Does the emergency unit provide outreach and mentoring service for basic emergency services at general 1
hospitals?

Is there access to OR and inpatient ward 1

Imaging center that has got MRI 0
Is there a patient decontamination area which is directly accessible from the ambulance bay without entering 1
any other part of the emergency department? (It should have a flexible water hose; floor drain and
contaminated water trap. It should have enough space for storage space of personal protective equipment)?
Is there an isolation area for potentially infectious patients? (It should have negative ventilation and should be 1
easily accessible from triage area to allow for the immediate isolation of patients)?
Is there an ambulance decontamination area? 0
Are there staff facilities with male and female staff changing area, locker, shower and toilet? 1
Is there a staff meeting room adjacent to the emergency department for morning meetings and other clinical 1
service discussions?
Is there a central oxygen line in the emergency department? (optional) 1
Laboratory service 1
Pharmacy service 1
Operation theater 1
Radiology service 0
Blood product service 1
Does the ED have access to these services on site? General surgery 1
Anesthesia 0
ICU service 0
Trauma services 1
General medicine 1
Mental health services 0
Ophthalmology 1
ENT 0
Hematology 1
Gastroenterology 0
Nephrology 0
Cardiology 1
Forensic medicine 0
Neurosurgery 0
Pediatric surgery 0
Infectious disease 0
Maxillofacial surgery 1
Dermatology 1
Pathology 1
Total 10.75%
 Material Resources (15%) (0.37)
Measurement Criteria Remark
Mandatory materials (0.6)
Total number of Beds (40) 0
Wheelchair (10) 0
Stretcher (10) 0
Crash cart (4) 0
Hard board (2) 1
Generator (for the whole facility) (1) 1
Water reserve tank (for the whole hospital) (1) 1
Defibrillator (2) 1
Sphygmomanometer (per each station) 1
Cardiac monitor (10) 0
Suction machine (6) 0
Oxygen cylinder (18) 1
Portable oxygen cylinder (5) 1
Flow meter (23) 1
IV stand (PER PATIENT BED) 1
Thermo-meter (per each station) 1
Stethoscope (per each station) 1
1. LMA 1
2. Oral airway (small, medium & large) 1
3. ETT (small, medium & large) & Pediatrics) 1
4. Laryngoscope 1
Air way equipment for
pediatric and adult 5. Stylet 0
6. Bugie 0
1. Nasal prong, catheter and facemask at least 20 each 1
Breathing equipment 2. BVM at least 5 0
3. NIPPV (CPAP/BIPAP) at least 6 0
Mechanical ventilator (non-portable) (per resuscitation bed) 0
Portable Mechanical ventilator (1) 0
Nebulizer (4) 0
 Syringe with different sizes (10) 1
IV Cannula with different sizes (6) 1
Neck collar (2) 1
Lumbar brace (2) 0
Crash cart Pelvic binder (2) 0
NS,RL & D5 (3 bags each) 1
NG tube, Urinary catheter and urine bag (2 each) 1
Minor set (1) 1
OPA, NPA (2 each) 1
Tongue depressor (1 pack) 1
Torch light (1) 1
Suturing set (1) 1
Minor wound care set Dressing set (1) 1
Minor surgical set (1) 1
Instrument tray (Troly) (1 per each station) 1
Suction tip (15) 0
Cricothyrodotomy set (2) 0
Pericardiocentesis set (2) 1
ECG machine (2) 1
Portable ultrasound (1) 1
POP (4) 1
Pulse Oximeter (6) 1
Glucometer (2) 1
Weight scale (2) 1
Safety box for sharp object disposal (12 or 2 per each station) 1
Blood fridge (1) 1
Refrigerator (1) 1
Siren (1) 0
Sub-total (Sum of all elements in this category multiplied by 0.6)

Desirable materials/equipment (0.3)

Portable X-ray (1) 0
Portable ultrasound with ECHO/Vascular (1) 1
Perfuser (7) 1
Oxygen Concentrator (8) 1
Venturi airway mask (5) 1
Pediatric Intraosseous set (2) 1
Central lines (2) 1
Tracheostomy set (2) 1
Fluid warmer (1) 0
Fetal heart monitor (1) 1
Hand held Doppler machine (1) 0
Supra pubic catheter set (2) 0
Sub-total (Sum of all elements in this category multiplied by 0.3)
Optional materials/equipment (0.1)
Traction kit (1) 1
Spirometer (1) 0
AED (1) 0
Fibrotic laryngoscopes (1) 0
Video laryngoscope (1) 0
Splinting (6) 0
Arterial lines (1) 0
Thoracotomy set (1) 0
Hoist (1) 0
Sub-total (Sum of all elements in this category multiplied by 0.1)
Total 18.3%
 Human Resource (20%) (CF1.17)
Emergency Trained General Practitioners ( 7 ) 0
Clinical Nurses (emergency trained and emergency BSC nurse) Nurse to patient ratio: red zone=1:1, Orange 1
zone =1:2, Yellow and Green zones =1:3 (16)
Emergency masters nurse (3) 0
Emergency and Critical care specialist (4) 0
Pediatric emergency subspecialist (2) 0
Ambulance crew ( 4 ) 0
Guard ( 8 ) 0
Runner (6) 0
Porter ( 10 ) 0
Social Worker ( 4 ) 0
Clinical pharmacist ( 2 ) 0
Data clerk ( 2 ) 0
Phlebotomist ( 4 ) 0
Cleaner ( 16 ) 0
Biomedical Engineer/ Oxygen 1
Technicians (1 focal person at a time)
Traumatologist 0
Toxicologist 0
Total 2.34%
 Laboratory tests (25%) (CF 3.52)
ER side lab (result received within than 1 hour) (0.6) Remark
CBC 1
Blood group and cross match 1
Urine analysis (Dipstick & microscopy) 1
PARASITOLOGY: Stool microscopy, Blood film 1
RDT 1
RBS 1
Urine HCG 1
SUB-TOTAL (Sum total of elements under this category multiplied by 0.6 24.64%
Result received within 4 hrs from main lab (0.3)
Body fluid analysis 1
CSF analysis 1
Sputum AFB 1
C-reactive protein 1
CHEMISTRY (Serum K+, Na++, Ca++… 0
Liver and renal function tests)
Thyroid function test 1
Coagulation profile 1
Cardiac markers 1
Arterial blood gas analysis 0
SUB-TOTAL (Sum total of elements under this category multiplied by 0.3) 2.1%
Result received after 4 hrs from main lab (0.1)
Culture 0
Toxicology screening 0
SUB-TOTAL (Sum total of elements under this category multiplied by 0.1) 0
Total 26.74%
 DRUGS AND SUPPLY (25%) (CF 0.26)

Medications Remark
Adenosine Injection,3mg/ml 0
Amiodarone Injection,50mg/ml 0
Digoxin Injection,0,1mg/ml, 0,25mg/ml 1
Metoprolol Injection,1mg/ml ,5mg/ml 1
Magnesium sulfate Injection,2%,5%,10%,20%,50% in 20ml 1
Sodium Chloride 0.9% (Normal Saline),500ml,1000ml 1
Atropine sulfate injection,1mg/ml in 1 ml ampoule 1
Hydralazine Injection,20mg/ml in 1 ml ampoule 1
Labetalol injection,5mg/ml, 1000mg/20ml ml 0
Nitroglycerin sublingual powder ,0.4 mg /SL 0
Nimodipine 0
Sodium Nitroprusside powder Injection,50mg in ampoule 0
Adrenaline injection,0.1mg/ml 1
Dopamine injection, 40mg/ml 1
Nor-Adrenaline injection,1mg/ml 1
Furosemide injection10mg/ml 1
Acetylsalicylic acid (ASA) Tablet, 71mg ,75mg & 81mg 1
Diclofenac Injection,25mg/ml in 3 ml ampoule,75mg/ml 1
Tramadol Injection,50mg/ml in 2 ml ampoule,100mg/ml 1
Pethidine Injection,50mg/ml in 3 ml ampoule,100mg/ml 1
Morphine injection 1mg/ml 1
Diazepam Injection,10mg/2ml 1
Phenytoin Injection, (2) 50mg, po 100mg 0
Haloperidol injection,5mg/ml in 1 ml ampoule 1
Promethazine injection,25mg/ml ,25mg/2ml in 1ml&2m 1
CIMETIDINE Injection,200mg/ml 1
OMEPRAZOLE injection ,2mg/ml suspension 1
Dexamethasone Injection,4mg/ml ,25mg/ml,50mg/ml 1
Hydrocortisone Injection,50mg/ml 1
Calcium Gluconate injection ,10mg in 10ml ampoule 1
Potassium chloride Injection,150mg/ml in 10ml, ampoule 1
Dextrose with water Injection ,5% in 1000ml 1
Ringer’s Lactate (Hartmann’s Normal) Injectable solution ,1000ml 1
Dextrose injection, 5% in 1000ml, 40% in 20ml 1
Oral rehydration salt powder (ORS) 1
Magnesium sulfate Injection ,20% in 10ml 1
Aminophylline Injection ,250mg/10ml in 10ml & 20ml 1
Salbutamol puff 1
Ketamine 1
Succinylcholine 1
Thiopental 1
Metoclopramide Drops,0.2mg/drop Injection,5mg/ ,50mg/2ml ampoule 1
Sodium bicarbonate Injection(concentrated),7.5%(40mEq/50ml)in ;8.4%(50mEq/50ml) 1
Dobutamine powder injection 250mg 1
Chlorpromazine hydrochloride Injection,25mg/ ,50mg/2ml 1
Hyoscine (scopolamine) butyl bromide Drops,5mg/5ml Injection,20mg/ml 1
Lidocaine hydrochloride Injection,5mg/ml,10mg/ml,20mg/ml 1
Procainamide hydrochloride Injection,100mg/ml vial 1
propranolol hydrochloride Injection,1mg/ml 1
Verapamil Injection,2.5mg/ml 1
Clopidogrel Tablet ,75mg 1
Enoxaparin Injection 20mg/0.2ml,40mg/0.4ml,60mg/0.6ml, 80mg/0.8ml ,100mg/ml 0
Heparin (UFH) Injection,1000U/ml,5000U/ml 1
Warfarin 1
Nitroglycerin powder ,0.4 mg/SL 1
Nitroglycerin sublingual, 0.4 mg/SL 1
Nitroglycerine injection 5mg/ml 1
Fosphenytoin 0
Phenobarbitone 1
Nimodipine injection,1mg/5ml 1
Esomeprazole 1
Hyoscine (scopolamine) hydro bromide Injection,0.45mg/ml,0.6mg/ml in 1ml 1
Sodium chloride Injection,0.9% (Normal Saline), 1000m;235mg/ml,3% in 500ml 1
Colloid 1
T3 1
T4 1
PTU 1
Iodine + Potassium Iodide 1
(Lugol’s solution) solution ,5% + 10 % 0
Methylprednisolone Injection (aqueous suspension),40mg/ml 0
Prednisolone Injection,10mg/ml 1
Insulin Regular, NPH soluble/Neutral 9 Human, procaine& Bovine, Injection, 1
Glucagon 1
Ipratropium bromide Aerosol, 20mcg/meter inhalation 1
Etomidate 1
Propofol 1
Vancomycin injection, 1000mg/10ml 1
Azithromycin injection,500mg 1
Cefepime IV 500mg or 1g powder injection, infusion 1g/50ml 1
Penicillin G 1.2 million unit/2ml 1
Ciprofloxacin infusion 200mg/100ml, 400mg/40ml, 250mg or 500mg tablet, suspension 250mg/5ml 1
Metronidazole infusion 599mg/100ml, tablet 250mg or 500mg 1
Acyclovir injection 50mg/ml, oral suspension 200mg/5ml, tablet 400mg or 800mg 1
Amoxicillin oral solution 125mg/5ml or 260mg/5ml, capsule 250mg or 500mg 1
Activated Charcoal Tablet,125mg,250mg, powder for reconstitution 15mg/120ml,25mg 1
Atropine Sulfate Injection,1mg/ml in 1 ml ampoule 1
Calcium Chloride Injection, 10%(100mg/ml), 13.6mEq 1
Protamine sulfate Injection,10mg/ml 1
Vitamin K Injection,10mg/ml in 1 ml ampoule 1
TAT Injection,1500IU/ml 1
Physostigmine Salicylate Injection, 1mg/ml in 1 ml and 2ml ampoule 1
Pralidoxime powder for injection, 1g/vial 1
Rabies Antiserum Equine Injection,200units in 5 ml 1
Snake Venom Antiserum Polyvalent Injection,10ml 1
Flumazenil 1
Total 22.1%
Grand Total 80.06%