A case study: Applying quality improvement methods to reduce pre-operative length of stay in a resource-constrained setting in Rwanda

Abstract

Objective: While several studies have focused on improving the quality of surgery, less attention has been paid to reducing pre-operative delays in care. We undertook a hospital quality improvement (QI) effort to reduce pre-operative delays in a teaching hospital in Rwanda. Without a coordinated admission schedule, many surgical patients arriving at the hospital for admissions were turned away because of unavailable beds. For those admitted for surgery, the pre-operative waits were long.Methods: A pre- and post-intervention study was conducted to examine the impact of a QI effort on two metrics: 1) pre-operative length-of-stay (LOS) for elective surgical patients, and 2) the number of elective surgical patients who were turned away on the scheduled admission date. Intervention: A multi-disciplinary work group utilized a Strategic Problem Solving Approach and implemented a centralized patient wait list and new schedule process utilizing the existing resources available at the hospital.Results: The percentage of elective surgical patients with a pre-operative LOS of more than two days was significantly lower in the post-intervention compared with the pre-intervention period (80% versus 26.8%, p-value < .001). The percentage of scheduled patients who were turned away due unavailable inpatient beds significantly decreased from 63.4% to 5.3%, p-value < .001.Conclusions: By following a methodical strategic problem solving approach, the pre-operative LOS was reduced, elective surgical patients turned away due to unavailable beds was decreased at very low financial cost.

Increasing patient medical record completion by assigning nurses to specific patients in maternity ward at Munini hospital

“…The strategic problem-solving approach is an eight-step systematic methodology that addresses and generates tangible solutions to quality of care issues. Many quality improvement projects that have adopted this methodology have seen positive results (Robinson et al , 2015; Byiringiro et al , 2015; Wong et al , 2012). To our knowledge, however, none concerning improving completeness of clinical documentation in Rwanda have been published.…”

Improving perioperative pain management: a preintervention and postintervention study in 7 developing countries

“…Medical faculty from high resource countries are increasingly involved in programs for teaching local physicians, residents, and allied personnel in developing countries and coupling this with QI projects. 34,44 PAIN OUT methodology has been used to perform single A&F projects in Kenya, Rwanda, and Gaza. 49 Our findings indicated the feasibility of data collection, but they also revealed some challenges.…”

Lessons learned in establishing a quality improvement project to reduce hospital acquired infections in the neonatology ward at a referral hospital in Rwanda

“…Many quality improvement initiatives using the SPS approach have demonstrated positive results in resource-limited settings (Wong et al , 2012; Robinson et al , 2015; Atnafu et al , 2015; Kmanzi et al , 2015). This case study describes the process of using SPS to implement a quality improvement project in a neonatology unit at a referral hospital in Rwanda.…”