Abstract:

Introduction: Emergency care is available in many forms in Swaziland and to our knowledge, there has never been a systematic study of emergency departments (EDs) in the country. The purpose of this study was to describe the characteristics, resources and capacity of emergency departments (EDs) in the Kingdom.

Methods: The National Emergency Department Inventory (NEDI)-International survey instrument (www.emnet-nedi.org) was used to survey all Swaziland EDs accessible to the general public 24/7. ED staff were asked about calendar year 2014. Data were entered directly into Lime Survey, a free, web-based, open-source survey application. Responses were analyzed using descriptive statistics, including proportions and medians with interquartile ranges (IQR).

Results: Sixteen of 17 EDs participated (94% response rate). Participating EDs were in either in hospitals (69%). EDs had a median of 53,399 visits per year (IQR 15,000 to 97,895). Fourteen (88%) EDs had a contiguous layout and the other 2 (12%) were noncontiguous. Overall, 8 (53%) had access to cardiac monitors and 11 (69%) had a 24/7 clinical laboratory available. Only 1 (6%) ED had a dedicated CT scanner, while 2 (13%) others had limited access through their hospital. The typical ED length-of-stay was between 1 and 6 hours (44%). The most commonly available specialists were general surgeons, with 9 (56%) EDs having them available for in-person consultation. No EDs had a plastic surgeon or psychiatrist available. Overall, 75% of EDs reported running at overcapacity.

Conclusions: Swaziland EDs were predominantly contiguous and running at overcapacity, with high patient volumes and limited resources. The limited access to technology and specialists are major challenges. We believe that these data support greater resource allocation by the Swaziland government to the emergency care sector.

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