A Quality Assessment of Clinical Service Utilization in a Geriatrics Unit in West Africa: 2014-2018

Abstract

Background: Quality healthcare requires learning organizations who demonstrate commitment to evaluation and improvement. The Geriatrics Unit in the 850-bedded University of Benin Teaching Hospital (UBTH), Nigeria, was set up in 2014 to provide quality healthcare to older persons. The goal of this evaluation was to assess the extent to which that initiative met its objectives. Methods: Using the Donabedian's framework, we undertook a formative review of key service elements in the Geriatrics Unit of UBTH from April 1, 2014 to March 31, 2018, using data from routine ward documentation. Results: The unit had a multidisciplinary team of doctors, nurses, physiotherapists, occupational therapists, pharmacists, medical social workers and support staff throughout the period in focus. All records were manually kept. In-patient numbers more than doubled within the first year, from 62 to 133. Increasing utilization was also evident in bed occupancy rates that rose from 20.1% in 2014 to a peak that exceeded the maximum capacity of open beds (112%) in 2017, and required closed beds to be opened. Bed turnover rates increased from 3.7 in 2014 to 22.2 in 2017. The median average length of stay was 13.9 days. Gross mortality rate ranged between 23% and 31.8%; annual fall rates between 0.4 and 3.0 falls per thousand patient days, and discharges against medical advice (DAMA) between 0.8% and 6.1%.Conclusion: Multi-disciplinary care was maintained in the geriatrics unit, and available beds were oversubscribed within the 4 years reviewed. Opportunities for improvement include moving on to electronic patient records; increasing the number of functional beds; achieving lower mortality rates. Our findings also provide benchmarks against which future evaluations and quality improvement interventions will be measured.