Emergency medicine is rapidly evolving across Africa, yet the field continues to face significant gaps in research quality, particularly in study design and implementation. To generate actionable evidence that reflects the acute care needs of African populations, it is critical to embed quality management measures within clinical research processes. This commentary describes the use of the Plan-Do-Study-Act (PDSA), a simple and reproducible quality improvement (QI) tool, as a mid-study quality audit strategy during the implementation of the “Pathways to Care for Patients with Acute Infectious Illnesses in Ghana” (PATHCARE) study. Over two weeks, trained evaluators conducted structured observations and interviews with research assistants (RAs) across five study sites in Kumasi, Ghana. The audit revealed protocol deviations related to patient screening, recruitment, informed consent, and data collection that threatened data integrity and participant protection. Based on these findings, a targeted refresher training was conducted, leading to measurable improvements in RA knowledge of study protocol. This experience highlights the feasibility and impact of embedding low-cost, iterative quality audits within emergency care research. Especially in resource-constrained settings with limited research infrastructure, tools like the PDSA can serve as pragmatic solutions to enhance data reliability, safeguard ethical standards, and ultimately, improve the quality and utility of clinical research in African emergency medicine.
Introduction Emergency Centre crowding is a persistent challenge, particularly in low- and middle-income countries, where resource constraints exacerbate mismatches between demand and capacity. Clinician productivity is central to EC flow and is typically measured using patients per hour (PPH), but this does not capture concurrent workload. The active queue (AQ), operationally defined as unresolved clinician-attributed patient episodes at any point during a shift, may complement PPH by capturing the concurrent nature of EC clinical work. This study aimed to describe AQ dynamics at a district-level EC and identify the clinician, shift, and flow factors associated with variation in queue size. Methods A retrospective cross-sectional secondary analysis was conducted using data from 1 289 clinician shifts across three four-week periods in 2019 at a South African district-level EC. AQ was derived from timestamped patient flow data. Associations with clinician, shift, and system-level factors were assessed using one-way ANOVA and Spearman's rank correlation. Results Median AQ was 1.50 (IQR 1.00–2.25), with a median peak AQ of 3.00 (IQR 2.00–4.00). AQ varied significantly by clinician category, employment type, and shift type (all p < 0.001), with higher values among senior clinicians and during night shifts. AQ remained stable at a median of 2.00 during the active working period before declining in the final shift quarter, while PPH declined progressively throughout. AQ and PPH were moderately correlated (rho = 0.43, p < 0.001). AQ was positively associated with patients waiting at shift start (rho = 0.19, p < 0.001) but not with patient acuity, despite acuity strongly suppressing PPH (rho = −0.44, p < 0.001). Conclusions Emergency clinicians routinely manage concurrent patient loads, with AQ demonstrating a consistent mid-shift plateau. AQ complements PPH by capturing the concurrent dimension of clinician workload that throughput measures alone cannot reflect, with relevance to staffing and operational planning in district-level EC settings.
Background While helmet use among motorcyclists in Africa remains low, an equally critical issue is the quality of helmets in use. In many African countries, such as Ghana, poor-quality helmets are widely available in local markets, mainly due to a lack of helmet standards, weak import regulations, and poor enforcement. This study, therefore, explores the determinants and enablers of access to quality motorcycle helmets in Ghana. Methods We conducted a qualitative inquiry between January and April 2024. We purposively sampled participants across three interest groups: motorcyclists, helmet vendors/retailers, and road safety practitioners. We collected data through in-depth, face-to-face interviews using semi-structured interview guides. We analysed the data using inductive thematic analysis. Results We interviewed 41 participants: 16 motorcyclists, 19 helmet vendors/retailers, and 6 road safety practitioners. The analysis highlighted four interconnected system gaps and potential enablers: limited knowledge and awareness of helmet quality, limited availability of quality helmets, economic constraints, and the absence of regulations and enforcement. Enablers include public education and awareness of quality helmets, improved market availability, price controls and incentives for motorcyclists, and stronger regulation and enforcement. Together, these factors limit access to quality helmets, and a systemic regulatory gap in standards and enforcement exacerbates the problem. Conclusion Improving access to quality helmets requires a coordinated approach. The first step is to address the regulatory gap by developing helmet standards. Without this, it is difficult to ensure market availability, raise public awareness, and make helmets more affordable.
Introduction This review examines how the outcomes of educational interventions used to improve emergency care are measured and reported. With an increasing demand for improved emergency care at all levels, many such interventions have taken the form of short courses that are not registerable as a formal professional qualification, yet the reporting and evaluation of their outcomes remains varied and unstandardised. The aim of this scoping review was to map and synthesize global literature on the evaluation and outcomes of emergency care short courses for healthcare professionals. Methods Published and unpublished literature (1996–2025) was searched in Sabinet, Scopus, Web of Science, Cochrane Library, MEDLINE (PubMed), and CINAHL. Search terms included emergency care short courses, outcomes, impact, evaluation, and healthcare professionals between November 2024 and June 2025. Grey literature searches included ProQuest dissertations, EMBASE conference abstracts, and hand-searching. Studies were screened, data extracted, and results summarized in tables and figures. Results Seventy-five multi-author studies published between 1996 and 2025 were included, predominantly using pre–post or quasi-experimental designs in clinical settings. Courses were typically delivered face-to-face over 1–5 days to a range of healthcare professionals, most commonly nurses and midwives, and spanned seven content domains, with general emergency care being the most frequent. Evaluations were conducted primarily immediately before (n = 50) and after (n = 54) training. Most studies assessed learning outcomes (n = 52) and learner reaction (n = 31), whereas fewer evaluated behaviour change (n = 22) or results-level outcomes (n = 7), with only a small number reporting outcomes across all four Kirkpatrick levels. Conclusion Despite a growing evidence base, evaluation of emergency care training remains largely confined to lower Kirkpatrick levels, leaving a critical gap in understanding how training translates into sustained clinical practice change and meaningful health system impact.
