A National survey describing the quality of care in Paediatric Emergency Departments of Tertiary Hospitals in Nigeria

Introduction: The outcome of paediatric emergency care is essential to the attainment of child-targeted sustainable development goals. We assessed the quality of paediatric emergency care among 34 tertiary Paediatric Emergency Departments (PED) in Nigeria. Methods: We conducted a cross-sectional process audit of recruited 34 PEDs in Nigeria. A paper questionnaire developed from the validated AAP/IFEM Guidelines for Care of Children in the ED was used to collect information on the PED settings, the processes of care and measurable patient outcome. Association between the regions, hospital volume category and other institutional attributes was conducted using chi-square, Results: The median (IQR) of paediatric visits and admissions to PEDs were 187.5 (120 - 300) and 107.5 (67 - 131) respectively. Over two-thirds (73.6 %,) of the PEDs had no set target Time-To-Physician consultation and the median (IQR) Length-of-Hospital Stay was 48 (0-72) hours.The majority of centres (90%) had patient safety tools but point-of-care-diagnostics (POCDs) were grossly deficient (23.5%). The mean protocol utilization score was 8.7 out of a maximum score of 34.The national crude death rate was 33.8 per 1000 children and there was no statistically significant relationship between the crude death rate and volume of hospital visits, (p-value=0.45) or geopolitical zones (p-value = 0.68). Conclusion: There was nationwide poor protocol utilization and non-availability of POCDs coupled with a high mortality rate at the PEDs. Development and utilization of locally relevant protocols and improvement in the availability of POCDs are essential. Keywords: Paediatrics; Emergency Department; Nigeria; quality of care; National survey.