Background Health systems around the world are being challenged by an on-going COVID-19 pandemic. The COVID-19 pandemic and associated response can have a significant downstream effect on access to routine health care services, and indirectly cause morbidity and mortality from causes other than the disease itself, especially in resource-poor countries such as Ethiopia. This study aimed to explore the impact of the pandemic on these services and measures taken to combat the effect. Methods The study was conducted at St. Paul’s hospital millennium medical college (SPHMMC) from December 15, 2020 to January 15, 2021 using a comparative cross-sectional study design. We collected data on the number of clients getting different essential health care services from May to October 2019 (Pre COVID) and the same period in 2020 (during a COVID-19 pandemic) from the patient registry book. The analysis was done with SPSS version 24 software. Result Overall, the essential services of SPHMMC were affected by the COVID-19 pandemic. The most affected service is inpatient admission, which showed a 73.3% (2044 to 682) reduction from the pre-COVID period and the least affected is maternal service, which only decreased by 13% (3671 to 3177). During the 6 months after the COVID-19 pandemic, there was a progressive increment in the number of clients getting essential health services. Conclusion and recommendation The establishment of a triple setup for fighting against COVID-19, which encompasses non-COVID services, an isolation center and a COVID-19 treatment center, played a vital role in preserving essential health services.

Background Failure mode and effect analysis is an important tool to identify failures in a system with its possible cause, effect, and set actions to be implemented proactively before the occurrence of problems. This study tries to identify common failure modes with its possible causes and effect to the health service and to plot actions to be implemented to reduce COVID-19 transmission to clients, staff, and subsequent service compromise from asymptomatic COVID-19 patients visiting the adult emergency department of SPHMMC (non-COVID-19 setup). Method and Study Design A multidisciplinary team, representing different divisions of the adult emergency department at St. Paul’s Hospital Millennium Medical College (SPHMMC), was chosen. This team was trained on failure mode and effect analysis and basics of COVID-19, to identify possible causes of failures and their potential effects, to calculate a risk priority number (RPN) for each failure, and plan changes in practice. Results A total of 22 failure modes and 89 associated causes and effects were identified. Many of these failure modes (12 out of 22) were found in all steps of patient flow and were associated with either due to lack of or failure to apply standard and transmission-based precautions. This suggests the presence of common targets for improvement, particularly in enhancing the safety of staff and clients. As a result of this FMEA, 23 general improvement actions were proposed. Conclusion FMEA can be used as a useful tool for anticipating potential failures in the process and proposing improvement actions that could help in reducing secondary transmissions during the pandemic.

Background:The higher demand for surgical services during the advancement of the COVID-19 pandemic has resulted from the need for a pre-admission negative result, the need for extra resources, and a shortage of skilled expertise. This quality improvement project aimed to reduce the in-hospital preoperative waiting time of elective cases to less than 24 hours. Methods: The study was conducted in a tertiary care center. Following the collection of baseline data, we formed a multidisciplinary team to analyze the root causes and intervention ideas of delay using fishbone and driver diagrams, respectively. We prioritize key drivers and implemented several low-cost interventions using Plan-Do-Study-Act (PDSA) model. We monitored the average inhospital preoperative waiting time of patients. Results: Overall, in-hospital preoperative waiting time for elective cases has been reduced from a baseline of 4.89 days to 1.32 days on average by the end of 10 months of initiating the project. Similarly, monthly elective case cancellation rate due to COVID-19related reason has been reduced from baseline 62.5% of the total cancellation to 0%. Due to this, the average monthly inpatient bed utilization has increased from 2.21 patients per month during pre-COVID-19 period to 5.9 patients per month in each bed of the surgical ward by the end of the project. Conclusion:The implementation of a quality improvement project can optimize operation theatre efficiency, inpatient bed utilization, and reduce the surgical backlog. Meticulous and rigorous effort has to be laid down to do root cause analysis, generate feasible change ideas, and continuous follow-up, and testing of multiple PDSA cycles is required to impact an improvement and sustain it in the long run. The emergence of COVID-19 pandemic could be used as an opportunity to reduce the length of stay in the hospital.

Background: Nearly all maternal complications that result in three-quarters of maternal deaths can be prevented by proper emergency referral procedures, early recognition of obstetric complications, and timely and adequate care. But, many women still face setbacks in timely accessing emergency obstetric interventions that will save their life. Aim: This project aimsto establish and deliver comprehensive emergency obstetric care at the highest referring catchment health center to St. Paul’s Hospital Millennium Medical College (SPHMMC) over a period of 16 months (from December 2020 to April 2022). Methods: A pre and post-intervention follow-up study design was employed to evaluate the impact of establishing and supporting a health center on the access and quality of maternal service. After identifying a highly referring catchment health center, we established a multidisciplinary team (MDT) responsible for preparing a readiness plan, facilitating staff training on comprehensive emergency obstetric care, resource mobilization, and continuous supportive supervision. Result:Caesarian section delivery, holistic obstetric ultrasound service, comprehensive abortion care, and antenatal care service were started. The total monthly delivery at Anne Dimma health center almost quadrupled from a baseline of 94 to an average of 334, referral out from the health center to SPHMMC decreased from a baseline of 156 mothers to a median of 12, and increased maternal emergency referral-in to Anne Dimma health center from the surrounding health center from zero to a median of 42.5. The total number of deliveries at SPHMMC decreased from a monthly average of 902 to a monthly average of 827 over the project period. Conclusion: Delivering comprehensive emergency obstetric care near the client’s home by empowering the catchment health center has a significant role in reducing unnecessary referrals and costs, overcrowding of tertiary hospitals, and increasing antenatal and postnatal care attendance and institutional delivery.

BackgroundHealth systems around the world are being challenged by on-going COVID-19 pandemic .The COVID-19 pandemic and associated response can have a significant downstream effect on access to routine health care services, and indirectly cause morbidity and mortality from causes other than the disease itself ,especially in resource-poor countries such Ethiopia. This study aimed to explore the impact of the pandemic on these service and measures taken to combat the effect.MethodsThe study was conducted at St. Paul’s hospital millennium medical college (SPHMMC). The study was conducted from December 15, 2020 to January 15, 2021 using comparative cross- sectional study design. We collected data on the number of clients getting different essential healthcare services from May to October 2019 (Pre COVID) and same period in 2020 (during COVID-19 pandemic) from patient registry book. The analysis was done with SPSS version 24 software.ResultOverall, the essential services of SPHMMC were affected by COVID-19 pandemic. The most affected service is inpatient admission that showed 73 % (2044 to 682) reduction from pre- COVID period and the least affected is maternal service, which only decrease by 13% (3671 to 3177). During the 6 months after COVID-19 pandemic, there is a progressive increment in number of clients getting essential health services.ConclusionThe establishment of a triple setup for fighting against COVID-19, which encompass; non COVID service, isolation centre and COVID-19 treatment centre played a vital role in preserving essential health services.