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Table 5 Challenges and potential solutions for implementing emergency department surveillance

From: The Pakistan National Emergency Department Surveillance Study (Pak-NEDS): Introducing a pilot surveillance

Challenges

Solutions

Access to institutions and EDs

Involvement of local Administrators/ED physicians as co-PIs in the study facilitated the approval process for the study from hospital administrations and institutional ethical review boards.

Overwhelming case load in public institutions

Motivation of local staff to contribute

In the absence of electronic records in most cases and illegible or incomplete patient records, the data collectors had to partially rely on information from the clinical staff on the ground, especially nursing staff. Communications with the staff facilitated by the local co-PIs and relevant senior officials e.g. head nurses, about the importance and relevance of the study to them, led to limited success but this remained a challenge because of high patient volume in public institutes. One institution (LRH) offered monetary incentives to staff for participation.

Limitations of technology

-No local electronic records in most cases

-No mechanisms for local data entry

-Free text entries

-Limited information available

-Limitation in obtaining real-time data as a result

Data collected on hard copies of questionnaire and transported to AKU where all data was entered on computers and then analyzed.

Free text entries were limited as much as possible by extensive coding lists made available to the data collectors but they still remained a challenge.

Variations in services distribution

A standard partially modifiable data collection plan was developed in consultation with nominees and adopted according to the local context in each institute. Data collectors were appointed along major patient flow pathways within the ED to come in contact with and potentially capture the maximum number of patients presenting to the Eds.

Sustainability

Although this was a pilot phase, efforts were made to maximize future sustainability if the project continued. This involved fostering local ownership with involvement of local co-PIs and other staff, utilizing existing data sources as much as possible, and minimizing any hindrance to local staff in performance of their regular duties because of the study.

Data management logistics

All questionnaires were tracked using the study ID numbers on being shipped to and receiving from the study sites. Field supervisors were informed of the batch numbers and were responsible for safe delivery of the forms back to AKU. The ID numbers and the number of patients captured by the surveillance system were tallied with the number of returned forms at AKU using information from the daily and weekly reports.

Worker oversight and quality control

Field supervisors monitoring of data collectors at all sites and random quality checks of data. Any issues were either rectified and reported by the supervisor, or referred to the local co-PI or study coordinator at AKU for resolution. Feedback was provided to field supervisors and to data collectors regarding quality issues in the received data.