Trends in mortality associated with opening of a full-capacity public emergency department at the main tertiary-level hospital in Tanzania

Hendry R. Sawe, Juma A. Mfinanga, Victor Mwafongo, Teri A. Reynolds, Michael S. Runyon

Emergency medicine is an emerging specialty in Sub-Saharan Africa, and most hospitals do not have a fully functional emergency department (ED). We describe the mortality rates of the Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania before and after the opening of a full-capacity ED. This retrospective study investigated ED and hospital mortality rates for patients admitted to MNH from January 2008 to January 2012. This period represents 2 years before and 2 years after the opening of the full-capacity ED in January 2010. Trained abstractors analyzed patient care logbooks, attendance registers, nurse report books, and death certificates. The January 2008 to December 2009 data are from the limited-capacity casualty room (precursor of the ED), and for February 2010 to January 2012, they are from the new ED. Data are presented as proportions or differences with 95 % confidence intervals (CIs). During the 4-year study period, the number of visits increased from 53,660 (January 2008 to December 2009) in the casualty room to 77,164 (February 2010 to January 2012) in the new ED. During this time, the overall hospital mortality rate decreased from 13.6 % (95 % CI 13.3-13.9 %) in the January 2008 to December 2009 period to 8.2 % (95 % CI 8.0-8.3 %) in the February 2010 to January 2012 period. The corresponding casualty room and ED mortality rates were 0.34 % (95 % CI 0.25-0.35 %) and 0.74 % (95 % CI 0.68-0.80 %), respectively. In the casualty room, the most commonly reported cause of death was lower respiratory tract infection and least common was poisoning. In the new ED, the most commonly reported cause of death was congestive cardiac failure and the least common was cancer. The opening of a full-capacity ED in a tertiary-level hospital in sub-Saharan Africa was associated with a significant decrease in hospital mortality. This is despite a small, but significant, increase in the mortality rate in the ED as compared to that in the casualty room that it replaced.