Surgical service monitoring and quality control systems at district hospitals in Malawi, Tanzania and Zambia: a mixed-methods study.
health services research
quality measurement
surgery
Journal
BMJ quality & safety
ISSN: 2044-5423
Titre abrégé: BMJ Qual Saf
Pays: England
ID NLM: 101546984
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
23
11
2020
revised:
22
02
2021
accepted:
07
03
2021
pubmed:
18
3
2021
medline:
31
12
2021
entrez:
17
3
2021
Statut:
ppublish
Résumé
In low-income and middle-income countries, an estimated one in three clinical adverse events happens in non-complex situations and 83% are preventable. Poor quality of care also leads to inefficient use of human, material and financial resources for health. Improving outcomes and mitigating the risk of adverse events require effective monitoring and quality control systems. To assess the state of surgical monitoring and quality control systems at district hospitals (DHs) in Malawi, Tanzania and Zambia. A mixed-methods cross-sectional study of 75 DHs: Malawi (22), Tanzania (30) and Zambia (23). This included a questionnaire, interviews and visual inspection of operating theatre (OT) registers. Data were collected on monitoring and quality systems for surgical activity, processes and outcomes, as well as perceived barriers. 53% (n=40/75) of DHs use more than one OT register to record surgical operations. With the exception of standardised printed OT registers in Zambia, the register format (often handwritten books) and type of data collected varied between DHs. Monthly reports were seldom analysed by surgical teams. Less than 30% of all surveyed DHs used surgical safety checklists (n=22/75), and <15% (n=11/75) performed surgical audits. 73% (n=22/30) of DHs in Tanzania and less than half of DHs in Malawi (n=11/22) and Zambia (n=10/23) conducted surgical case reviews. Reports of surgical morbidity and mortality were compiled in 65% (n=15/23) of Zambian DHs, and in less than one-third of DHs in Tanzania (n=9/30) and Malawi (n=4/22). Reported barriers to monitoring and quality systems included an absence of formalised guidelines, continuous training opportunities as well as inadequate accountability mechanisms. Surgical monitoring and quality control systems were not standard among sampled DHs. Improvements are needed in standardisation of quality measures used; and in ensuring data completeness, analysis and utilisation for improving patient outcomes.
Sections du résumé
BACKGROUND
In low-income and middle-income countries, an estimated one in three clinical adverse events happens in non-complex situations and 83% are preventable. Poor quality of care also leads to inefficient use of human, material and financial resources for health. Improving outcomes and mitigating the risk of adverse events require effective monitoring and quality control systems.
AIM
To assess the state of surgical monitoring and quality control systems at district hospitals (DHs) in Malawi, Tanzania and Zambia.
METHODS
A mixed-methods cross-sectional study of 75 DHs: Malawi (22), Tanzania (30) and Zambia (23). This included a questionnaire, interviews and visual inspection of operating theatre (OT) registers. Data were collected on monitoring and quality systems for surgical activity, processes and outcomes, as well as perceived barriers.
RESULTS
53% (n=40/75) of DHs use more than one OT register to record surgical operations. With the exception of standardised printed OT registers in Zambia, the register format (often handwritten books) and type of data collected varied between DHs. Monthly reports were seldom analysed by surgical teams. Less than 30% of all surveyed DHs used surgical safety checklists (n=22/75), and <15% (n=11/75) performed surgical audits. 73% (n=22/30) of DHs in Tanzania and less than half of DHs in Malawi (n=11/22) and Zambia (n=10/23) conducted surgical case reviews. Reports of surgical morbidity and mortality were compiled in 65% (n=15/23) of Zambian DHs, and in less than one-third of DHs in Tanzania (n=9/30) and Malawi (n=4/22). Reported barriers to monitoring and quality systems included an absence of formalised guidelines, continuous training opportunities as well as inadequate accountability mechanisms.
CONCLUSIONS
Surgical monitoring and quality control systems were not standard among sampled DHs. Improvements are needed in standardisation of quality measures used; and in ensuring data completeness, analysis and utilisation for improving patient outcomes.
Identifiants
pubmed: 33727414
pii: bmjqs-2020-012751
doi: 10.1136/bmjqs-2020-012751
pmc: PMC8606427
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Pagination
950-960Commentaires et corrections
Type : CommentIn
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Glob Health Action. 2020 Dec 31;13(1):1765526
pubmed: 32476620
Ann Surg. 2012 Dec;256(6):925-33
pubmed: 22968074
World J Surg. 2018 Jun;42(6):1610-1616
pubmed: 29209733
Lancet. 2008 Jul 12;372(9633):139-144
pubmed: 18582931
BMC Med. 2018 Mar 1;16(1):32
pubmed: 29495961
Health Policy Plan. 2015 Oct;30(8):985-94
pubmed: 25261799
Lancet. 2015 May 30;385(9983):2209-19
pubmed: 25662414
Annu Rev Public Health. 2014;35:29-45
pubmed: 24188053
Surgery. 2015 Jul;158(1):17-26
pubmed: 25958067
BMJ Qual Saf. 2014 Apr;23(4):299-318
pubmed: 23922403
Lancet Glob Health. 2016 May;4(5):e320-7
pubmed: 27102195
N Engl J Med. 2009 Jan 29;360(5):491-9
pubmed: 19144931
PLoS One. 2013 Jun 12;8(6):e65428
pubmed: 23776482
Pilot Feasibility Stud. 2019 Feb 18;5:25
pubmed: 30820336
BMJ Glob Health. 2019 Apr 16;4(2):e001282
pubmed: 31139445
Br J Surg. 2020 Jan;107(2):e151-e160
pubmed: 31903586
Lancet. 2012 Dec 15;380(9859):2054
pubmed: 23245596
Lancet. 2007 Oct 20;370(9596):1453-7
pubmed: 18064739
Hum Resour Health. 2019 Jul 22;17(1):60
pubmed: 31331348
Br J Surg. 2018 Jul;105(8):927-929
pubmed: 29770959
Br J Anaesth. 2018 Oct;121(4):813-821
pubmed: 30236243
Bull World Health Organ. 2011 Oct 1;89(10):757-65
pubmed: 22084514
J Am Coll Surg. 2011 Aug;213(2):231-5
pubmed: 21622011
Health Aff (Millwood). 2009 Sep-Oct;28(5):w876-85
pubmed: 19661113
Br J Surg. 2019 Jan;106(2):e156-e165
pubmed: 30620067
Int J Qual Health Care. 2002 Dec;14 Suppl 1:89-95
pubmed: 12572792
World J Surg. 2020 Sep;44(9):2857-2868
pubmed: 32307554
Clin Microbiol Infect. 2006 Dec;12(12):1224-7
pubmed: 17121630
World J Surg. 2015 Apr;39(4):856-64
pubmed: 24841805
Can J Anaesth. 2019 Feb;66(2):218-229
pubmed: 30484168
PLoS One. 2015 Sep 01;10(9):e0136156
pubmed: 26327392
Ann R Coll Surg Engl. 1988 Nov;70(6):363-5
pubmed: 3207327
World J Surg. 2013 Nov;37(11):2505-6
pubmed: 23989465
BMC Health Serv Res. 2013;13 Suppl 2:S9
pubmed: 23819699
Can J Anaesth. 2015 Dec;62(12):1259-67
pubmed: 26419248
Lancet Glob Health. 2018 Nov;6(11):e1196-e1252
pubmed: 30196093
Lancet. 2015 Aug 8;386(9993):569-624
pubmed: 25924834
N Engl J Med. 2020 Jan 30;382(5):397-400
pubmed: 31995684
Lancet. 2018 Apr 21;391(10130):1571
pubmed: 29695338
Int J Surg. 2014;12(5):2-6
pubmed: 24239705
Bull World Health Organ. 2005 Aug;83(8):578-83
pubmed: 16184276
BMC Health Serv Res. 2008 Sep 22;8:190
pubmed: 18808678
Malawi Med J. 2017 Sep;29(3):240-246
pubmed: 29872514
Lancet. 2015 Apr 27;385 Suppl 2:S29
pubmed: 26313076
BMC Health Serv Res. 2017 Jan 10;17(1):23
pubmed: 28073361
BMC Health Serv Res. 2014 Feb 26;14:91
pubmed: 24572013
Lancet. 2019 May 11;393(10184):1973-1982
pubmed: 30929893
PLoS One. 2011;6(6):e20776
pubmed: 21677788
J R Soc Med. 2014 Jun 9;107(1 suppl):34-45
pubmed: 24914127
Health Serv Res. 2013 Dec;48(6 Pt 2):2134-56
pubmed: 24279835
Lancet Glob Health. 2016 Mar;4(3):e165-74
pubmed: 26916818
BMJ. 2012 Mar 13;344:e832
pubmed: 22416061
Int J Qual Health Care. 2011 Aug;23(4):456-63
pubmed: 21672922