Exploration Of The Door To Needle Time Gap Of Administering Anti- Venom Serum (AVS) And Its Determinants: A Mixed-Method Study

Abstract

Abstract:-A mix method study was conducted at the Teaching hospital, Anuradhapura (THA) to describe the demographic characteristics of snake bites, determine the median time gap of administering anti-venom, identify reasons for delaying administration of anti-venom serum and propose measures to be adopted in order to shorten the door to needle time gap. Ethical approval was obtained by ethical committee, Faculty of Medicine, KDU. The descriptive cross-sectional part was based on snake bite victims elder than 16 years(n=50) who were admitted to the THA and received AVS (Anti-venom serum) therapy over a 3 ½ months period from 15th July 2019 and 50 victims were sample size for quantitative study. The data was collected through an interviewer administrated questionnaire .Participants were purposively recruited for the qualitative study and in-depth interviews were conducted with health care professionals in THA and peripheral hospitals. Qualitative data analyzed by thematic analysis with four themes including limited physical and human resources, issues in the diagnosis of envenoming, delays in preparation of AVS, reasons and delays in transferring patients from the local hospital to THA. Data were analyzed by using SPSS 23 with Mann- Whitney U test. There were 88% (44) male and 12% (8) female victims. The most bites were not identified (50%) and most of the common bite were Russell's viper (46%).Below the ankle 82% and between 6 a.m. to 6 p.m. was the commonest bite site and time. There were 40 (80%) indirect admissions and 10 (20%) direct admissions. Door to needle median gap of all direct and indirect admission was 125 (IQR= 65-158) minutes. Door to needle median gap in indirect admissions was 178 (IQR=90-210) minutes and direct admissions median gap was 72 (IQR=30-104) minutes. There was a significant difference between the median time gap of indirect and direct admissions. Poor rural hospital facilities, overcrowding, inadequate staffing and the unavailability of quality tubes for whole blood clotting time are the main factors contributing to the time gap. Final suggestions are increasing bed capacity and implementation of a triage system in the ETU.