Department of Paediatrics, Honiara National Referral Hospital, Honiara, Solomon Islands.
Centre for International Child Health, University of Melbourne, Parkville, Victoria, Australia.
Arch Dis Child. 2018 Jul;103(7):685-690. doi: 10.1136/archdischild-2017-314662. Epub 2018 Apr 4.
While maternal and perinatal mortality auditing has been strongly promoted by the World Health Organization (WHO), there has been very limited promotion or evaluation of child death auditing in low/middle-income settings. In 2017, a standardised child death review process was introduced in the paediatric department of the National Hospital in Honiara, Solomon Islands. We evaluated the process and outcomes of child death reviews. The child death auditing process was assessed through systematic observations made at each of the weekly meetings using the following standards for evaluation: (1) adapted WHO tools for paediatric auditing; (2) the five stages of the audit cycle; (3) published principles of paediatric audit; and (4) WHO and Solomon Islands national clinical standards of Hospital Care for Children. Thirty-three child death review meetings were conducted over 6 months, reviewing 66 neonatal and child deaths. Some areas of the process were satisfactory and other areas were identified for improvement. The latter included use of a more systematic classification of causes of death, inclusion of social risk factors and community problems in the modifiable factors and more follow-up with implementation of action plans. Areas for improvement were in communication, clinical assessment and treatment, availability of laboratory tests, antenatal clinic attendance and equipment for high dependency neonatal and paediatric care. Many of the changes recommended by audit require a quality improvement team to implement. Child death auditing can be done in resource-limited settings and yield useful information of gaps which are linked to preventable deaths; however, using the data to produce meaningful changes in practice is the greatest challenge. Audit is an iterative and evolving process that needs a structure, tools, evaluation, and needs to be embedded in the culture of a hospital as part of overall quality improvement, and requires a quality improvement team to follow-up and implement action plans.
虽然世界卫生组织（WHO）大力提倡孕产妇和围产期死亡率审核，但在中低收入国家，儿童死亡审核的推广或评估非常有限。2017 年，在所罗门群岛霍尼亚拉国家医院的儿科部门引入了标准化的儿童死亡审查程序。我们评估了儿童死亡审查的过程和结果。通过在每周会议上进行系统观察，使用以下评估标准来评估儿童死亡审核过程：（1）适合儿科审核的 WHO 工具；（2）审核周期的五个阶段；（3）已发表的儿科审核原则；以及（4）WHO 和所罗门群岛国家医院儿童护理临床标准。在 6 个月的时间里进行了 33 次儿童死亡审查会议，审查了 66 例新生儿和儿童死亡。该过程的一些方面令人满意，但其他方面需要改进。后者包括更系统地对死因进行分类，将社会风险因素和社区问题纳入可改变因素，并在实施行动计划后进行更多随访。需要改进的领域包括沟通、临床评估和治疗、实验室检测的可用性、产前诊所就诊情况以及高依赖新生儿和儿科护理设备。审核建议的许多改进措施都需要质量改进团队来实施。在资源有限的环境中可以进行儿童死亡审核，并提供有用的信息，这些信息与可预防的死亡有关；然而，利用这些数据在实践中产生有意义的变化是最大的挑战。审核是一个迭代和不断发展的过程，需要有一个结构、工具、评估，并作为整体质量改进的一部分嵌入医院文化中，还需要一个质量改进团队来跟进和实施行动计划。
