Emergencies and severe illness
Quick Check+ training curricula for district hospital clinical team
Using a participatory, case-based approach, health workers from all cadres of the district hospital clinical team (clinicians; managers; and auxiliary staff) are trained in emergency management and ongoing care for severely ill patients. Improving basic skills in the emergency administration of lifesaving oxygen, fluids and antimicrobials and skilled ongoing care of adult patients with severe respiratory distress and shock can save the lives of many adults who come to the district hospital.
The clinical training is based on the guidance in the WHO IMAI District Clinician Manual; the Quick Check algorithm for adult triage, emergency assessment and emergency treatments in Section 2 of the manual appears on a wallchart which is used during the training and subsequently posted for reference in the emergency department (link to generic Wallchart; link to SEARO wallchart when posted).
For the clinical training (for doctors and nurses at district hospitals), there are 3 participant training modules:
Quick Check Essentials Care in the first hours is critical and so must be widespread with decentralization to smaller hospitals. This aims at improving skills in rapid triage assessment, oxygen administration and other emergency treatments, and a consistent approach to initial fluid resuscitation and when to initiate vasopressors, from the emergency department to inpatient ward or on transfer to an ICU.
Manage the Severely Ill Patient with Severe Respiratory Distress and Septic Shock This includes guidance on ongoing management of severely ill patients with septic shock and/or severe respiratory distress, including differential diagnosis, investigations, monitoring, safe administration of peripheral vasopressors in the absence of central line capacity, escalating respiratory care, and preventing complications.
IPC for clinicians is integrated within the training, to prepare health workers to understand and implement appropriate IPC precautions including which PPE and isolation procedures for various priority pathogens with person-to-person transmission. Clinicians are trained to implement screening and IPC recommendations to protect health workers when first encountering a patient with a suspected priority disease with person-to-person transmission at the very start of emergency care guidelines (“Safety first”). IPC training includes hands-on skills training (in skill stations) on donning and doffing full PPE, how to remove contaminated gloves, and other skills which are often missing in critical care training.
The managers training is based on a health facility assessment (prior to the training) of the oxygen supply (SEARO-IMAI oxygen survey PDF and excel) and the availability of other supplies, equipment and staffing necessary for quality emergency care and management of severe illness. The managers/senior administrators learn the basics of the Quick Check approach and are prepared to plan for staff training and mentoring after training and to improve the physical resources required to implement IMAI Quick Check and management of severely ill patients- including oxygen, other supplies and equipment, structure and layout for caring for SARI patients, and adequate ventilation; quality improvement, monitoring and evaluation; and how to work with the clinical team to create an action plan for implementation.
The auxiliary training for hospital auxiliary personnel teaches participants to recognize emergency signs in adolescents and adults and to call for help. This allows them to identify patients who require immediate and urgent assessment and treatment. This course also includes infection prevention and control. It is aimed at various staff including health care providers with limited clinical background (e.g. nursing assistants or laboratory technicians); gatekeepers; registrars in the emergency ward or OPD; general assistants; and hospital transport personnel.
Practical sessions- As with the other courses, auxiliary participants participate in practical sessions and role-playing cases with expert patient-trainers (EPTs). They will also have sessions in the hospital identifying real patients with emergency signs in a supervised setting.
Regional/Country Adaptations- There are several adapted versions of the Quick Check+ training course.
Quick Check/acute care at the health centre
The Acute Care guideline module aimed at health workers in a health centre includes a simpler version of the Quick Check algorithm and treatment recommendations, to support rapid recognition of emergency signs and effective pre-referral treatment for severe disease, as well as effective outpatient management for acutely ill patients without signs of severity.
The Acute Care guideline module and training were included in the WHO IMAI HIV first level facility learning program from its start in 2004 to address the acute management of opportunistic infections and other common clinical problems at health centre level and was updated in 2009. This module provides an adult equivalent to the IMCI chart booklet and training program. An updated version has been adapted in Uganda for use in the NCD clinical training program.