Validation of an Electronic Surgical Outcomes Database at Mbarara Regional Referral Hospital, Uganda

Anderson, Geoffrey A.; Ilcisin, Lenka; Ngonzi, Joseph; Ttendo, Stephen; Twesigye, Deus; Benitez, Noralis Portal; Firth, Paul G.; Nehra, Deepika

doi:10.1007/s00268-017-4172-7

Cited by 16 publications

(9 citation statements)

References 21 publications

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“…We found that almost all the studies focused on either safety32–35 40–42 44–46 48 51–53 59–81 and/or effectiveness of care, with a lack of focus on other domains of quality. The prioritisation on safety was not surprising given the well-recognised magnitude of the patient safety problem21 and the resultant global movement to improve patient safety.…”

Section: Discussionmentioning

confidence: 98%

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

Brima

Morhason-Bello

Charles³

et al. 2022

BMJ Open

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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

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Section: Discussionmentioning

confidence: 98%

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

Brima

Morhason-Bello

Charles³

et al. 2022

BMJ Open

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“…A strength of the study was that the chart review was exhaustive with minimal missing data, which overcomes a common problem for tracking outcomes in resource-limited settings. 35 The intervention was performed as a quality improvement initiative, without any intentional changes in documentation or detection of complications. We do not know if the impact will be sustained over a more extended time period, and further analysis of future patients is warranted.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Surgical Critical Care Service Reduces Failure to Rescue in Emergency Gastrointestinal Surgery in Rural Kenya

et al. 2021

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Objective: We aimed to evaluate the implementation of a dedicated Surgical critical care service (SCCS) on failure to rescue (FTR) rates in rural Kenya. Summary Background Data: FTR adversely impacts perioperative outcomes. In the resource-limited contexts of low-and middle-income countries, emergency gastrointestinal surgery carries high morbidity and mortality rates. Quality improvement initiatives that decrease FTR rates are essential for improving perioperative care. Methods: All patients who underwent emergency gastrointestinal surgery between January 2016 and June 2019 at Tenwek Hospital in rural Kenya were reviewed. Critical care capabilities were constant throughout the study period. A supervised surgical resident was dedicated to the daily care of critically ill surgical patients beginning in January 2018. The impact of the SCCS initiation on the outcome of FTR was evaluated, controlling for patient complexity via the African Surgical Outcomes Study Surgical Risk Score. Results: A total of 484 patients were identified, consisting of 278 without and 206 with an active SCCS. A total of 165 (34.1%) patients experienced postoperative complications, including 49 mortalities (10.1%) yielding an FTR rate of 29.7%. The FTR rate decreased after SCCS implementation from 36.8% (95% CI: 26.7%-47.8%) to 21.8% (95% CI: 13.2%-32.6%) (P = 0.035) despite an increase in the average patient African Surgical Outcomes Study score from 14.5 (95% CI, 14.1-14.9) to 15.2 (95% CI, 14.7-15.7) (P =0.03). Conclusions: The implementation of an SCCS in rural Kenya resulted in decreased rates of FTR despite an increase in patient complexity and severity of critical illness.

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“…Chart selection: we obtained the medical records numbers of all women admitted to MRRH maternity ward from a surgical services quality assessment registry created to track surgical outcomes at MRRH. All maternity ward hospitalizations were captured using this registry between 2013 and 2014 and coded by admission diagnosis [ 15 , 16 ]. The registry included details on surgical procedures and hospital outcomes but did not include clinical documentation such as vital signs.…”

Section: Methodsmentioning

confidence: 99%

Quality of vital sign monitoring during obstetric hospitalizations at a regional referral and teaching hospital in Uganda: an opportunity for improvement

Mugyenyi¹,

Ngonzi²,

Wylie³

et al. 2021

Pan Afr Med J

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Introduction vital sign monitoring is a key component of safe facility-based obstetric care. We aimed to assess quality of care around vital sign monitoring during obstetric hospitalizations in a tertiary-care facility in a resource-limited setting. Methods retrospective review of obstetric records at a tertiary care facility. We assessed documentation of vital signs including fetal and maternal heart rate, and maternal blood pressure, temperature, oxygen saturation and urine output. The primary outcome was the quality of vital sign monitoring (high- versus low-quality based on frequency of monitoring). We compared quality of monitoring with timing of admission, presence of complication, and delivery mode using chi-squared tests. Results among 360 records of obstetric admissions (94% of a planned random sample), 96% documented a delivery. Of these, 8% of pregnant women and 11% of postpartum women had high-quality vital sign monitoring documented on initial evaluation at admission. For women delivering during the hospitalization, 0.8% of women delivering had high-quality monitoring in the first four hours postpartum, with higher rates of high-quality monitoring in women delivering vaginally compared to those delivered by cesarean (1.4% versus 0%, p<0.001). There were no differences in rates of quality monitoring by time of admission, or obstetric complication. Conclusion very few obstetric hospitalizations had high-quality vital sign monitoring. Attention towards improving vital sign monitoring is a critical need.

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Validation of an Electronic Surgical Outcomes Database at Mbarara Regional Referral Hospital, Uganda

Cited by 16 publications

References 21 publications

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

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

Implementation of a Surgical Critical Care Service Reduces Failure to Rescue in Emergency Gastrointestinal Surgery in Rural Kenya

Quality of vital sign monitoring during obstetric hospitalizations at a regional referral and teaching hospital in Uganda: an opportunity for improvement

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