Medical documentation in sudden onset disasters: A review of the introduction and incorporation of the agreed WHO minimum data set for emergency medical teams

Abstract

When responding to disasters, international emergency medical teams (EMTs) face many challenges. Due to the high pressure and unfamiliarity of the situation, priorities become pressured. One such priority which finds itself low on the list of immediate concerns has historically been medical documentation. The World Health Organisation (WHO) sought to address this by developing a minimum data set (MDS) for daily reporting, which would be expected every day, from every EMT. Although a step in the direction toward standardising practice, several hurdles remain. Firstly, we do not yet know in practice how this MDS would feature and function in the individual medical record-keeping process. Secondly, poor prioritisation of documentation may have been highlighted as a concern, and a standard template for reporting may now exist, but we are yet to understand the experiences of clinical practitioners with regards medical documentation in this setting and what solutions they believe might address the challenges. Thirdly now a recommended MDS exists we need to establish if it will deliver data that can be used to shape the better distribution of healthcare resources in sudden onset disasters. This study addresses these questions using techniques drawn from action research, qualitative research and quantitative research. The findings suggest that: 1) the WHO MDS can be adapted into an individual patient record however the process requires considerable ongoing testing and design to maximise its success 2) the universal challenges of medical record-keeping in disasters do however, still remain resulting from in-practice perception of relative low priority, poor incentivisation of quality documentation and record formats being unfit for purpose; and whilst practitioners recognise the benefits and limits to both paper and electronic documentation, the key requirement is developing bespoke solutions for the international disaster environment 3) as an example of its utility at providing data, the injury categorisation of the MDS, demonstrates moderate inter-rater agreement with a kappa of 0.59 [CI 0.49,0.69] In conclusion the WHO MDS does have the potential to generate useful daily data and quality assure EMT practice through a standardised patient record. Further study needs to address the integration of the MDS within individual records focusing on the specific documentation challenges EMTs continue to face.

Date of Award	1 Aug 2019
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Fiona Lecky (Supervisor) & Tony Redmond (Supervisor)