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Reductions in Inpatient Mortality following Interventions to Improve Emergency Hospital Care in Freetown, Sierra Leone 1 2 3 4 5 Matthew Clark *, Emily Spry , Kisito Daoh , David Baion , Jolene Skordis-Worrall 1 Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, 2 Welbodi Partnership, Unit 14, Garrick Industrial Centre, London NW9 6AQ, 3 Minstry of Health and Sanitation, 4th floor Youyi Building, Freetown, Sierra Leone, 4 Ola During Children’s Hospital, Fourah Bay Road, Freetown, Sierra Leone, 5 UCL Centre for International Health Development, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH Abstract Background: The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children’s hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. Methods and Findings: A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children’s Hospital, Freetown, Sierra Leone. Following focus group discussions, five priority areas were identified to improve emergency care; staff training, hospital layout, staff allocation, medical equipment, and medical record keeping. A team of international volunteers worked with local staff for six months to design and implement improvements in these five priority areas. The improvements were evaluated collectively rather than individually. Before the intervention, the inpatient mortality rate was 12.4%. After the intervention this improved to 5.9%. The relative risk of dying was 47% (95% CI 0.369–0.607) lower after the intervention. The est