Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions

Abstract

ObjectivesTo systematically review existing literature on hospital-based quality improvement studies in sub-Saharan Africa that aim to improve surgical and anaesthesia care, capturing clinical, process and implementation outcomes in order to evaluate the impact of the intervention and implementation learning.DesignWe conducted a systematic literature review and narrative synthesis.SettingLiterature on hospital-based quality improvement studies in sub-Saharan Africa reviewed until 31 December 2021.ParticipantsMEDLINE, EMBASE, Global Health, CINAHL, Web of Science databases and grey literature were searched.InterventionWe extracted data on intervention characteristics and how the intervention was delivered and evaluated.Primary and secondary outcome measuresImportantly, we assessed whether clinical, process and implementation outcomes were collected and separately categorised the outcomes under the Institute of Medicine quality domains. Risk of bias was not assessed.ResultsOf 1573 articles identified, 49 were included from 17/48 sub-Saharan African countries, 16 of which were low-income or lower middle-income countries. Almost two-thirds of the studies took place in East Africa (31/49, 63.2%). The most common intervention focus was reduction of surgical site infection (12/49, 24.5%) and use of a surgical safety checklist (14/49, 28.6%). Use of implementation and quality improvement science methods were rare. Over half the studies measured clinical outcomes (29/49, 59.2%), with the most commonly reported ones being perioperative mortality (13/29, 44.8%) and surgical site infection rate (14/29, 48.3%). Process and implementation outcomes were reported in over two thirds of the studies (34/49, 69.4% and 35, 71.4%, respectively). The most studied quality domain was safety (44/49, 89.8%), with efficiency (4/49, 8.2%) and equitability (2/49, 4.1%) the least studied domains.ConclusionsThere are few hospital-based studies that focus on improving the quality of surgical and anaesthesia care in sub-Saharan Africa. Use of implementation and quality improvement methodologies remain low, and some quality domains are neglected.PROSPERO registration numberCRD42019125570

Expanding surgical access in Africa through improved health insurance schemes: A review

“…Many programs rely on voluntary enrollment, leaving a substantial portion of the population needing more coverage. [ 22 ] Furthermore, there is often an urban-centric focus, with rural and underserved areas receiving less attention and fewer resources. [ 22 ] Geographical barriers, such as the distribution of healthcare facilities, can create access challenges, particularly for rural populations.…”

“…[ 22 ] Furthermore, there is often an urban-centric focus, with rural and underserved areas receiving less attention and fewer resources. [ 22 ] Geographical barriers, such as the distribution of healthcare facilities, can create access challenges, particularly for rural populations. [ 23 ] The inaccessibility of healthcare facilities in remote areas further hampers the utilization of health insurance for surgical care.…”

Implementation of Surgical Safety Checklist : Literature Review

“…Dalam penelitian Risanti didapatkan hasil adanya hubungan motivasi dengan kepatuhan perawat dalam menerapkan SSC (15). Hasil penelitan tersebut sejalan dengan penelitian yang dilakukan oleh Brima (2022) yang menyatakan bahwa terdapat hubungan antara motivasi dengan kepatuhan perawat dalam pelaksanaan prosedur keselamatan pasien di (7,12,13). Hal ini dikarenakan motivasi merupakan energi yang dapat mendorong seseorang untuk bersemangat melaksanakan pekerjaannya dalam rangka untuk mencapai tujuan yang telah ditetapkan.…”

“…Pendekatan semacam ini dapat menarik seseorang untuk melakukan sesuatu, sehingga munculah motivasi. (13)(14)(15)(16)(17) Pengetahuan perawat tentang SSC di ruang operasi menunjukan bahwa perawat yang memiliki tingkat pendidikan tinggi cenderung memiliki tingkat pengetahuan yang baik (16). Perilaku yang tidak didasari oleh pengetahuan dan kesadaran maka perilaku tersebut tidak akan berlangsung lama.. Hal ini berkaitan dengan perkembangan dari ilmu keperawatan, kedalaman dan luasnya ilmu pengetahuan akan mempengaruhi kemampuan perawat untuk berpikir kritis dalam melakukan tindakan keperawatan.…”

Achieving global surgical excellence: an evidence-based framework to guide surgical quality improvement programs in low and middle income countries

“…Similarly in a systematic review by Brima et al, of the 49 articles that reported hospital-based quality improvement studies in Africa, use of the surgical safety checklist comprised 29% and reduction of surgical site infections comprised 25% ( 15 ). Other interventions well-known to high income settings such as antimicrobial stewardship programs and streamlined postoperative care protocols are lacking in LMICs ( 14 , 15 ). As all countries move toward self-sufficient surgical systems, practical and adaptable guidelines are needed to inform quality improvement initiatives across unique national, regional, and local settings.…”