The health care system in Palestine is strained to the breaking point with population health needs outpacing system resources. Emergency departments draw a large, young patient population with high levels of critical illnesses and mortality, and are under-resourced, minimally organized, and often staffed by providers with no specialized training in emergency care. This combination of large volumes, high acuity, and low quality makes a compelling case for investing in emergency care, with several examples showing that dramatic improvements in health outcomes can be achieved – and measured – with targeted interventions.

Project Goal

The Health, Nutrition, and Population Global Practice at the World Bank Group in partnership with Juzoor is leading a new activity entitled “Strengthening Emergency Care in Palestine” aiming to develop and apply a module to improve Emergency care outcomes in Palestine and to contribute to the knowledge base, which will allow this work to be replicated across relevant FCV settings. The work is divided into four phases: 

Phase 1: instrument design & pilot: An instrument was designed to ascertain and identify areas for intervention in Palestinian emergency departments. The instrument primarily collected hospital administrative data and patient data from medical records and patient observation. 

Phase 2: Baseline and needs assessment data collection: The instrument was implemented in select emergency departments in Palestine, where the intervention will take place. Select facility and patient characteristics and operational metrics were collected; these will serve as input into the design of the intervention as well as serving as a baseline for evaluation of the intervention. Some information collected is noted below: 

Facility characteristics

·   Annual patient volume

·   Catchment size

·   Hospital size

·   Pediatric rate

·   Trauma rate

·   Staff level of training

·   Availability of essential resources (water, electricity)

Patient characteristics

·   Age

·   Gender

·   Home address

·   Mode of arrival

·   Referral source

·   Triage severity score

·   Chief complaint

·   Diagnosis

·   Disposition

·   Cause of death

Operational metrics

·   Admission rate

·   Intensive care unit (ICU) admission rate

·   Arrival to provider time

·   ED length of stay

·   In-ED mortality rate

·   Rate of dead upon arrival

Phase 3: Intervention design & implementation: Data collected and analyzed serve as input into Phase 3 intervention that will focus on improving specific elements of the emergency care system in the participating hospitals. A training intervention to implement and expand emergency triage at major emergency care centers in Palestine and to implement checklists for medical and trauma presentations has been conducted.