Audit and re-audit regarding the current practice of ABCDE approach in the emergency department at selected university hospitals in Syria

Background

The ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) is crucial for the initial assessment and treatment of critically ill patients. However, previous studies have shown suboptimal adherence to this protocol, highlighting the need for clinical audits.

Aim

To evaluate the extent of application of the ABCDE approach and to discover the obstacles that prevent them from being applied in internal emergency Department at selected university hospitals in Syria.

Methods

A clinical audit was conducted over two cycles at two university hospitals (hospital A and B), involving 160 patients. The first cycle took place from November 6 to November 19, 2023, and the second one from March 31 to April 9, 2024. Twenty-nine criteria based on World Health Organization guidelines were assessed using a checklist completed by a data collection group. The snapshot sampling method was used in determining the sample size and the convenient method to select patients. After the first cycle, findings were presented locally, leading to formulated recommendations.

Results

Both Hospitals showed improvement in compliance rates over the second cycle. Hospital A achieved 17.2% in the second cycle, while hospital B reached 20.6%. Hospital B had fewer declines and more criteria met, indicating a more favourable trend in patient care standards overall.

Conclusion

The audit also identified barriers to adherence, such as issues related to wearing gloves and ensuring patient privacy. The study concluded that regular clinical audits enhance the application of the ABCDE approach and improve healthcare delivery, emphasizing the need for ongoing research in this area.