arsi university, cohs, asella referral and teaching hospital

Arsi University, CoHS, Asella Referral and Teaching Hospital

Launching ceremony of ICU And

Private wing establishmentNov 15,2016

Asella Referral and Teaching Hospital

Background information

• Asella Hospital which was founded in 1964 G.C

Haile Silassie First Hospital

had a capacity of 60 beds

staffs:-one general practitioner, two nurses, four advanced health Assistants & two elementary health assistants

one junior health assistant training school

• The name was changed to Asella Hospital after the revolution of Derg regimes in 1975.

Background information

• Renovated in 1992 G.C by the Ethio-Italian cooperation

Bed capacity was 215 and also has Nursing school since then

• Serves for about 3.5 million populations in Arsi and the nearby zones

• Arsi University established in Sept 2014 GC.

(50 years younger than the hospital)

Back…..

• In 2008G.C, the hospital was given to ASTU to serve as teaching hospital school of health sceinces

• Since then 2 batches of medical doctors( 90 and 101) were graduated

Background….

• Has 321 beds:-

56 medical beds

54 surgical beds

30 Obs and 29 Gyn beds

54 pediatric and 47 neonatal beds

15 fistula beds

30 emergency beds and 6 ophthalmic beds

Staffs of the College/hospital

staffs In 1999 E.C 1n 2009 E.C

surgeon 2 6

internist 1 5

obstetrician 2 4

pediatrician o 5

radiologist 1 2

General practitioners 10 42

nurses 71 186

Lab staffs 12 29

Pharmacy staffs 7 31

anesthesia 2 10

dental 1 3

radiographer 2 5

Residency study leave 0 52

Instructors on activity

Instructors on study leave

Major activities of Hospital/college

• As a teaching hospital, it gives service to patients, students and also for research activities

• For patient service, the hospital is organized under 3 dpts;- OPD, Inpatient dpt, Emergency dpt

Major activities….activities In 1999 E.C 1n 2008 E.C

Outpatient attendant 54,831 120,000

Inpatient dpt 8,238 15,388

Emergency room attendance 2273 11,138

Inpatient mortality rate 350/8238=4.2% 399/15,388= 2.6%

Emergency room death rate 149/2273=6.5% 87/11,138= 0.8%

Total delivery 2114 5,312

C/S 173(8%) 1,318(24%)

Institutional maternal death 13/2114=0.61% 12/5312=0.23%

ANC 1553 2,636

Total operation 773 2981

Fully vaccinated children 461 893

U/S 901 5000

X ray 3633 15,365

1.Outpatient Department

• Medical, Surgical, Gyn & Obs, pediatric, radiology and imaging, dental, Eye, Psychiatry, MCH, different clinics, Pharmacy and laboratory

• 120,000 clients visited OPD in 2007E.C

450 new cases/day

Eye unit

• Secondary Eye Care Unit/SECU

• Supported by Orbisinternational

• Has 1 Ophthalmologist, 1 cataract surgeon, 5ophthalmic nurses & 2optometrist

• 8.5% of OPD visit

Radiology and imaging

• The unit is staffed with 2 radiologist, 6 radiographers and 2 dark room workers

• Has 1 old x ray and 1 digital x ray machine and 1 U/S

• 15,365 X ray films in 2008E.C

• 5000 U/S performed in 2008E.C

Digital x ray and U/S

Laboratory unit….performing only 70% of expected tests

Diabetic center

• Established 3 years back in collaboration with Adama University community service program

• About 900 adult and 60 pediatric diabetic patients

• Free insulin is provided frequently

ART clinic

• Established in 1998E.C

• Ever enrolled-11,976

• Currently on clinical care-3352

• Gives mentorship for 13 ART centers , 5 PMTCT center and 2 hospitals

Cervical cancer screening and treatment

• Established since Hamle 2002 E.C

• Staffed with 4 trained nurses and 2 specialists

• 1675 patients served since establishment(230 pre cancer lesion & 3 suspected for advanced cancer )

• Only 60 patients received service in2008 and 20 in 2009E.C

• Service is provided for free

• underutilized

2.Inpatient department

• Organized mainly under 4 major clinical departments

• 280 beds

• 15,388 admissions last year

• Deaths from admission-339 in last year

• Average hospital patient stay=5 days

Obstetric ward

• Around 36 beds in the ward with 3 delivery coachs

• 4 gynecologist and obstetrician

• 18 midwiferies

• 5312 total deliveries in 2008E.C(first in Oromia region)

• 1,318(24%) emergency C/S in the same year (24.8% of the whole deliveries)

Fistula unit

Fistula unit

• Established in 2011G.C in collaboration with ASTU,AHSC and WAHA

• Mainly perform fistula surgery

• 134 patients in 2007 and 120 patients in 2008 E.C

Neonatal ICU

• Established 4 years back

• Has 41 beds(including KMC)

• 16 nurses and 1 HO

• 1800 admission in 2008 E.C(150/month)

• 73 deaths(8% of admission)

• NMR=3/1000 live births

• Most deaths are preterms

Operation room/Theatre

• One major OR for the hospital

• 4 OR tables for major surgical obstetric and ophthalmic operation

• Significant improvement in the area after University involvement(3 Anesthesia machine, autoclave, cauthery machine, recovery room)

• 2981 patients operated totally in 2008(3480 operation in 2007E.C)

Major activities(KPI)…

• 1. outpatient attendances- 120,000 patients

(445 patients/day at OPD)

• 2.Emergency room attendance-11,138

(31 patients/day)

• 3.Patient triaged with in 5 minutes at Emergency Room=95%

Major activities(KPI)…

• 4.Proportion of ER attendance with length of stay <24 hours=37%(expectation=100)

• 5.Emergency room mortality

=87/11,138= 0.8%(expectation <2%)

• 6.Inpatient mortality

=399/15388= 2.6%(expectation<5%)

Major activities(KPI)…

• 7.total institutional deliveries = 5312

• 8.Proportion of delivery by C/S

=1318/5312= 24.8%

• 9.Institutional maternal mortality ratio

=12/5312=0.23%(240/100,000 live births)

(current national=370/100,000)

Major activities(KPI)…

• 10.total blood received from Blood bank

1474(60 % of need)

blood wastage rate=74/1474=5%

• 11.Gene expert performance

1475(95% of expectation) with 6 cases with rifampicin resistance

• 12.Client satisfaction is 68% (expectation 85% and above)

Major activities(KPI)…

• 12.Total surgeries in hospital=2981

(1588-gyn/Obs and 1393 surgery)

• 13.Total referral=910(1% of hospital visit)

• 14.EHRIG from 11% to 71%

Major improvements after the establishment of Arsi university

1.Collaboration with stakeholders(FMOH,ORHB)

>donation of Digital x ray machine, 3 anasthesiamachine from FMoH

> Dopler U/S , Gene Expert machine and car donated fro ORHB

>one full container medical supplies

> CPAP machines and incubators

>Delivery couches

>ICU equipment(full package)

Major improvements…..

2.Expansion of maternity and neonatal ward by building 100 beds capacity building(under construction)

Major improvements…..

3.Water supply:-water project is under construction with more than 40 million birr

4.Kitchen and cafeteria for students

Major improvements…..

5.Medication and supplies

adequate budget is allocated

(from 2.5 million to 13 million birr)

6. Laboratory and other medical equipments:-

33 million birr financed to purchase equipments

7. Autoclave and monitoring machines also purchased

Major improvements…

8.General ICU

• MOH donated all equipments coasted 1.8 million birr

• University contributed in renovation of the room

General ICU

• Significantly reduces patient referral

• Scale up the quality of service and standard of the hospital

• Serves also for teaching esp. the specialty program

• Contributes in the reduction of patient mortality

ICU…lesson from establishment

1.Cooperation for the same goal departments,FMOH, Workshops,individuals

2.Commitment….a process of more than a year

3.Stand for given and ungiven responsibility‘’one step forward from our routine activity’’

4.Energy for our next activities….

5.Stakeholders engagment

9. Private wing service

• Guideline from FMOH for in 2007E.C

• Our hospital has been on process for the last 10 months

• 1.2 million birr provided from university for establishment

• Service will start soon

10.Blood bank establishment

• Arsi university highly committed to establish blood bank in Asella

• Negotiation with stake holders already made

• Master plan completed and building site of 1000sqm donated by Asella town administration

• Construction will start soon

11.Usage of internal revenue

• Since this year, all internal revenue was transferred to the university

• But now permitted to use it

• The hospital planned to collect 10 million birr as an internal revenue

Fee free service in the hospital

1. ANC(including investigation and immunization)

2. EPI service

3. Tuberculosis and leprosy treatment

4. AFB and Gene expert investigation for TB

5. Fistula management

6. Delivery service(including C/S)

Fee free service…

7. Art service(including VCT,PICHT)

8. 24 hour emergency cases

NEWLY ADDED

9.Cervical cancer screening and treatment

10.Neonatal service

plan to add more

Next activities/plans

a, Improve emergency care

b, Automation of all services in the hospital(including card room)

c, Implementation of APTS(near to finish)

d, Accreditation of laboratory unit in all services

Next activities….

e, Full implementation of Health Care financing system

f, Improve our imaging service

g, Scaling up the hospital to Comprehensive Specialized Hospital level

h, improve implementation of all hospital reforms to >95% level

Next activities….

i. Launching of residency program since January

j. Community based pharmacy

Major challenges/problems

• Transportation shortage

• Inadequate Infrastructure and space

• Ambulance

• Lack of Blood bank(delainess)

• Lack of some Specialties like dermatologist, psychiatrist

• NO treatment center for MDR TB patients

• No center for trauma patients

• Commitment

ACKNOWLEDGEMENTS

• FMOH

• Arsi university

• All clinical departments

• Workshops

• Finance and purchasing teams

• AMEREF

• Dr Aschalew, Dr Bereket, Ato Elias

Thank you

We have many heroes in hospital but we need SUPERHEROESlike Dr BEREKET