Systemic emergency department performance in a low resource tertiary health facility in central Kenya: Micro level emergency care system evaluation

Emergency care system (ECS) performance is a proxy indicator of emergency care (EC) response and health systems resilience. The Emergency Care and System Assessment tool (ECSA) provides a structure for measuring emergency department (ED) systemic performance, using high quality ECS metrics. These metrics aligned with WHO targeted priority action areas facilitate synergies in supporting ECS evaluation at the micro level. Retrospective file reviews and anecdotal evidence from a low resource tertiary health facility between 1st January 2020 – 31st May 2021 showed that: - the governance structure had administrative and financial autonomy from the public healthcare system, healthcare financing was mostly out of pocket (OPP) and the human resource ecosystem was structured in operations, enforcement and training to drive EC quality improvement. More than two thirds of the patients were high acuity but only 2% of the patients died. Most sentinel ED functions were available at the facility however the facility does not have a developed prehospital care, neurosurgical nor a burns unit. Micro ECS framework derived from ECSA objectively interrogates performance of the healthcare system that supports EC in a tertiary facility.