Queries related to equipment

[joehcollins]

(@EvaJanouskova, @tbhallett ) Issue started just to track any queries related equipment use in the model which may need input during validation from clinical experts.

Routine Antenatal Care:

• Listening in of Foetal heart sounds reccomended durings vistits 2-8. Three potential peices of equipment which could be used for this 'Stethoscope, foetal, monaural, Pinard, plastic', 'Detector, foetal heart, ultrasonic, portable, Doppler' and 'Fetoscope'. Currently included Pinard as assumed to be most widely available.
• Both 'Sphygmomanometer' (manual BP equipment) and 'Blood pressure machine' listed in resource file. Unclear the exact indication for manual over electronic although manual quoted in ANC guidelines. As such have listed Sphygmomanometer (similarly i have used sphygmomanometer in labour/PNC HSIs for consistency)

[EvaJanouskova]

note: related to #1124

[joehcollins]

Labour/delivery care:

• Should a resuscitaire only be used for babies who require resuscitation or should it be available for all deliveries? Currently included
• Cardiotocography (CTG) won't be indicated for all women (unsure if there is high availability of equipment) but dont currently know what the correct indication is? Not currently included
• Same question relating to oxygen delivery indications
• For assisted vaginal delivery ive requested both forceps and 'Vacuum extractor' - not 100% sure this is the obstetric extractor.
• For caesarean section - unsure of the difference in equipment between a laparotomy and hysterectomy set. Currently using laparotomy set.

[joehcollins]

Post abortion care:

• Under what circumstances would oxygen be delivered - O2 equipment not currently included
• dilatation and curettage is reccomended treatment for incomplete miscarriage/abortion. No current equipment for this however manual vacuum aspiration set is included in the resource file so have currently included this.

[joehcollins]

General query - want to confirm that equipment should only be updated when an intervention is successfully delivered (i.e. the consumable are available)? This is the approach i have taken for specific interventions with HSIs

[joehcollins]

ALRI:

• pulse oximeter is currently a consumable within master which determines treatment. I have also added as a piece of equipment
• x-ray listed as a consumable but not seemingly called. If chest xray indicated then equipment needs to be logged

[joehcollins]

NCDS:

• unsure of correct 'analyser' to use for blood testing for diabetes, ischaemic kidney/heart disease. currently have added haematology and chem/electrolytes. There are likely other equipment bits related to the lab.
• weighing scale vs digital scale?

For emergency care (stroke and MI):

• assumed that dx_test for stroke would likely include CT head in line with UK clinical practice. I will double check standard treatment guidelines if this is included there (unsure of Britta's source for clinical guidelines)
• there doesnt appear to be any equipment for conducting an electrocardiogram (ECG) which is part of diagnosis for MI. i have added the 'patient monitor' equipment which likely includes some form of cardiac monitoring.

[joehcollins]

RTIs (generally needs a closer eye from a ED clinician) :

• Unclear what ICU equipment is needed by those taking ICU days. This will vary according to which organ is being supported (respiratory - invasive ventilation, AKI - haemofiltration etc.)
• equipment availability for severe cases (shock, TBI) would vary by facility level - do we need to consider this
• open fracture treatment is likely surgical, but not clear if individuals also receive the surgical HSI.

[joehcollins]

Cancers

• For biopsy a microscope is required. There are 4 microscope types in the equipment list - i've gone for 'ordinary microscrope' in the first instance.

[EvaJanouskova]

@tbhallett , @joehcollins, How about making the packages, so we add a column into the RF_Equipment which will have the name of the package in it, if it belongs to any. And we create a fnc which will be able to read all equipment based on the package name.

Suggested pkgs:

• surgery pkg
• x-ray pkg
• lab pkg

Is that it, or do we need more?

[joehcollins]

@EvaJanouskova that sounds good - i think they are the main packages at the moment that I can think of. There maybe one around delivering IV drugs also

[EvaJanouskova]

note from @joehcollins (I think, he was talking about cancers modules): There were some consumables that are present in ResourceFile_Consumables_availability_and_usage but not ResourceFile_Consumables_Items_and_Packages. Some of them are quite essential (PSA test for prostate cancer) and others were actually equipment (endoscope/cystoscope). We just need to decide what to do with these consumables and update the code accordingly. (youll see from my comments the issue)

[EvaJanouskova]

Re Pkgs:
Do we want 2 different pkgs for minor and major surgery?

[EvaJanouskova]

Decisions made within a meeting (Tim H, Joe, Eva; see notes from the meeting):

• equipment packages
  • minor surgery pkg: 'Infusion pump', 'Drip stand', 'Blood pressure machine', 'Pulse oximeter'
  • major surgery: 'Infusion pump', 'Drip stand', 'Blood pressure machine', 'Pulse oximeter', 'Laparotomy Set'
  • x-ray pkg: 'X-ray machine', 'X-ray viewer'
  • ANC pkg: 'Weighing scale', 'Measuring tapes', 'Stethoscope, foetal, monaural, Pinard, plastic'
  • ICU pkg: 'Analyser, Combined Chemistry and Electrolytes', 'Analyser, Haematology', 'Patient monitor', 'Drip stand', 'Infusion pump', 'Blood pressure machine', 'Pulse oximeter', 'Trolley, emergency', 'Stethoscope', 'Oxygen cylinder, with regulator'
    note: intersections of some pkgs = > update equip pkg fnc
• items to be joined into one (When the items are removed, check with Newton what to do about item numbering, is it already in use? If so, better just to have a gap between item nmbs. Otherwise, it could be renumbered.)
  • 'Stethoscope, foetal, monaural, Pinard, plastic', 'Detector, foetal heart, ultrasonic, portable, Doppler' and 'Fetoscope' --> 'Stethoscope, foetal, monaural, Pinard, plastic'
  • 'Sphygmomanometer' , 'Blood pressure machine' --> 'Blood pressure machine' (update for routine ANC, labour, PNC)
  • weighing scale, digital scale --> weighing scale (update for NCDs)
  • microscopes (update for cancers)
• add new items to RF_Equipment
  • electrocardiogram
  • ICU set - (ventilator (not current equipment)) for those taking ICU days (rti module)
  • anaesthetic machine (for major surgery)
• delete old HSI in @joehcollins' PR/other PR
  • HSI_CareOfWomenDuringPregnancy_FocusedANCVisit
• check standard treatment guidelines
  • is head CT used within dx_test for stroke? (Emergency care (stroke and MI)) / for @joehcollins to do
• open issue
  • Open fracture treatment is likely surgical, but not clear if individuals also receive the surgical HSI. (rti module) / for @joehcollins to do
• write down questions for health professionals