Browne Joyce L, van Nievelt Sabine W, Srofenyoh Emmanuel K, Grobbee Diederick E, Klipstein-Grobusch Kerstin
Julius Global Health, Julius Centrum for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
Ridge Regional Hospital, Ghana Health Service, Greater Accra Region, Accra, Ghana.
PLoS One. 2015 Apr 29;10(4):e0125749. doi: 10.1371/journal.pone.0125749. eCollection 2015.
Severe pre-eclampsia and eclampsia are one of the major causes of maternal mortality globally. Reducing maternal morbidity and mortality demands optimizing quality of care. Criteria-based audits are a tool to define, assess and improve quality of care. The aim of this study was to determine applicability of a criteria-based audit to assess quality of care delivered to women with severe hypertensive disorders in pregnancy, and to assess adherence to protocols and quality of care provided at a regional hospital in Accra, Ghana.
Checklists for management of severe preeclampsia, hypertensive emergency and eclampsia were developed in an audit cycle based on nine existing key clinical care protocols. Fifty cases were audited to assess quality of care, defined as adherence to protocols. Analysis was stratified for complicated cases, defined as (imminent) eclampsia, perinatal mortality and/or one or more WHO maternal near miss C-criteria.
Mean adherence to the nine protocols ranged from 15-85%. Protocols for 'plan for delivery' and 'magnesium sulphate administration' were best adhered to (85%), followed by adherence to protocols for 'eclampsia' (64%), 'severe pre-eclampsia at admission' (60%), 'severe pre-eclampsia ward follow-up' (53%) and 'hypertensive emergency' (53%). Protocols for monitoring were least adhered to (15%). No difference was observed for severe disease. Increased awareness, protocol-based training of staff, and clear task assignment were identified as contributors to better adherence.
A criteria-based audit is an effective tool to determine quality of care, identify gaps in standard of care, and allow for monitoring and evaluation in a health facility, ultimately resulting in improved quality of care provided and reduced maternal morbidity and mortality. In our audit, good adherence was observed for plan for delivery and treatment with magnesium sulphate. Substandard adherence to a number of protocols was identified, and points towards opportunities for targeted improvement strategies.
重度子痫前期和子痫是全球孕产妇死亡的主要原因之一。降低孕产妇发病率和死亡率需要优化医疗服务质量。基于标准的审核是一种定义、评估和改善医疗服务质量的工具。本研究的目的是确定基于标准的审核在评估为妊娠期重度高血压疾病女性提供的医疗服务质量方面的适用性，并评估加纳阿克拉一家地区医院对协议的遵守情况及所提供的医疗服务质量。
在一个审核周期内，根据九项现有的关键临床护理协议制定了重度子痫前期、高血压急症和子痫管理的检查表。对50例病例进行审核以评估医疗服务质量，医疗服务质量定义为对协议的遵守情况。分析针对复杂病例进行分层，复杂病例定义为（即将发生的）子痫、围产期死亡和/或一项或多项世界卫生组织孕产妇接近死亡C级标准。
对九项协议的平均遵守率在15%至85%之间。“分娩计划”和“硫酸镁给药”协议的遵守情况最佳（85%），其次是“子痫”协议（64%）、“入院时重度子痫前期”协议（60%）、“重度子痫前期病房随访”协议（53%）和“高血压急症”协议（53%）。监测协议的遵守情况最差（15%）。在严重疾病方面未观察到差异。提高意识、对工作人员进行基于协议的培训以及明确任务分配被确定为更好遵守协议的促成因素。
基于标准的审核是确定医疗服务质量、识别护理标准差距以及在医疗机构中进行监测和评估的有效工具，最终可提高所提供的医疗服务质量并降低孕产妇发病率和死亡率。在我们的审核中，观察到分娩计划和硫酸镁治疗的遵守情况良好。发现对一些协议的遵守情况未达标准，这指出了有针对性的改进策略的机会。
