Kampala Emergency Digital Transport System (KEDTS)

ABOUT KAMPALA EMERGENCY DIGITAL TRANSPORT SYSTEM (KEDTS)

The Kampala Emergency Digital Transport System innovation was borne out of the United States Agency for International Development (USAID) implementation research project called the Maternal and Newborn health project (MaNe). Formative studies conducted in the project’s first year highlighted various barriers to the uptake and utilization of pre-hospital emergency care within the urban poor population.

1. Very few public ambulances are available to meet the needs of the urban poor. Kampala Capital City Authority (KCCA) has only seven ambulances. The existing private ambulances are not leveraged and not well coordinated in addition to the high costs.
2. Poor real-time coordination and view of ambulances in Kampala city for emergency response for maternal and newborn cases (MNH) and other cases including empty referrals, poor patient preparedness and pre-referral care for referring units, poor anticipation of the referral by the receiving facility, and inability to ascertain outcomes and feedback on the referrals made.
3. Poor documentation of the referrals reduced the opportunity for learning from the referrals made.

The Kampala Emergency Digital Transport System (KEDTS) has been developed to address the above issues through improved coordination of the scarce public ambulance resource, leveraging the private sector, data, and documentation for decision-making, and outcomes of the referred cases.

ABOUT KEDTS

The Kampala Emergency Digital Transport system is a free online referral platform designed
with support from USAID. The system has two modules: the Interfacility module (facility to facility referrals) and the Community module (Community to facility referrals). The platform has interfaces for the facilities (both referring and referral facilities), an interface at the call and dispatch center through which the coordination of all referrals is done, and the ambulance interface for the ambulance teams.

• The interfacility module: When a request is made by a given facility that is referring to a client, the call and dispatch center is notified as well as the intended receiving facility. The case is then triaged and an ambulance is dispatched accordingly. The ambulance is tracked in real-time at all levels including the referring facility, the call center, and the receiving facility.

           Figure 1 Micro Level features of the interfacility module.

• The Community Module: An open-source application available on the Google play store, the Kampala Ambulance Services, is part of the KEDTS platform through which community members can register and be able to request a nearby ambulance with guidance from the call and dispatch center for both private and public ambulances through an ‘Uber-like’ fashion with the agreed price ranges regulated by Kampala Capital City Authority (KCCA).

EVALUATION AND RESULTS

Through the in-built timestamps, the system captured timestamps for response and the response time. Response time has been captured right from the time a call is made, the time an ambulance is dispatched, and the time an ambulance takes in the facility, up to the time it reaches the destination facility. In addition, the system has been able to capture outcomes of referred patients accessed through the patient delivery report.

Referring facilities have been able to log in and decipher the interventions undertaken for a particular referral. This has provided opportunities for learning and decision-making for similar cases.

LESSONS LEARNED

• Few facility staff are tech-savvy. As a result, the team had frequent handholding and mentorship sessions with facilities that supported the use of the system. Even with the mentorship, dedicated staff is required to make entries to request emergency transportation and, if on the receiving end, to be able to make entries of the outcome of the patients.
• Working with ministries, departments and agencies has enabled the uptake of the application.
  Uganda Healthcare Federation (UHF) has enabled the scale-up and enrolment of many private facilities.
• The provision of mobile data for ambulances and facilities has enabled seamless use of the application.
• The tagging system used on the performance has improved uptake by the ambulance teams, especially the drivers and the emergency medical technicians.
• Having paramedics take the lead in the use of the application has facilitated quality hand-over reports and completion of the referral loop.
• The devices on the ambulance should be fixed onto the ambulance to enable real-time location of the ambulance at all times.
• Training users is more effective on-site, and utilization of system champions per facility is vital for uptake and sustainability of the digital solution.

CONCLUSION

The Kampala Emergency Digital Transport System has been utilized to coordinate and streamline maternal and newborn emergencies, COVID-19 referrals, and other medical emergencies within the Kampala Metropolitan area. Private and public facilities have been oriented on this system and continue with enthusiasm to create both micro and macro networks for referral.

Having all this information on one system has allowed for a central repository of all referral data within Kampala. This allows for real-time reporting, data analysis, evidence generation, and informed decision-making at the management level. The system is currently being linked to the Ministry of Health through the DHIS2 portal and there is potential for integration with the existing Uganda Open Electronic Medical Records to further merge patient records.