Dartmouth-Hitchcock Medical Center, Lebanon, NH, US.
Botswana-Harvard AIDS Institute Partnership, Gaborone, BW.
Ann Glob Health. 2019 Mar 4;85(1):22. doi: 10.5334/aogh.1354.
Mortality among adult general medical admissions has been reported to be high across sub-Saharan Africa, yet there is a paucity of literature on causes of general medical inpatient mortality and quality-related factors that may contribute to the high incidence of deaths. Based on a prior study at our hospital as well as our clinical experience, death early in the hospitalization is common among patients admitted to the adult medical wards.
Quantify early inpatient mortality and identify factors contributing to early in-hospital mortality of medical patients in a resource-limited hospital setting in Botswana.
Twenty-seven cases of patients who died within 48 hours of admission to the general medical wards at Scottish Livingstone Hospital in Molepolole, Botswana from December 1, 2015-April 25, 2016 were retrospectively reviewed through a modified root cause analysis.
Early in-hospital mortality was most frequently attributed to septic shock, identified in 20 (74%) of 27 cases. The most common care management problems were delay in administration of antibiotics (15, 56%), inappropriate fluid management (15, 56%), and deficient coordination of care (15, 56%). The most common contributing factors were inadequate provider knowledge and skills in 25 cases (93%), high complexity of presenting condition in 20 (74%), and inadequate communication between team members in 18 (67%).
Poor patient outcomes in low-and middle-income countries like Botswana are often attributed to resource limitations. Our findings suggest that while early in-hospital mortality in such settings is associated with severe presenting conditions like septic shock, primary contributors to lack of better outcomes may be healthcare-provider and system-factors rather than lack of diagnostic and therapeutic resources. Low-cost interventions to improve knowledge, skills and communication through a focus on provider education and process improvement may provide the key to reducing early in-hospital mortality and improving hospitalization outcomes in this setting.
在撒哈拉以南非洲，成人综合医学住院患者的死亡率一直很高，但关于综合医学住院患者死亡原因和可能导致高死亡率的质量相关因素的文献却很少。基于我们医院的一项先前研究以及我们的临床经验，在成人内科病房住院的患者中，住院早期死亡很常见。
量化住院早期死亡率，并确定博茨瓦纳资源有限的医院环境中导致内科患者住院早期死亡的因素。
通过修改后的根本原因分析，回顾性分析了 2015 年 12 月 1 日至 2016 年 4 月 25 日期间在博茨瓦纳莫莱波洛莱的苏格兰利文斯顿医院综合内科病房入院后 48 小时内死亡的 27 例患者的病例。
住院早期死亡率最常归因于败血症性休克，在 27 例病例中占 20 例（74%）。最常见的护理管理问题是抗生素给药延迟（15 例，56%）、液体管理不当（15 例，56%）和护理协调不足（15 例，56%）。最常见的促成因素是 25 例（93%）提供者知识和技能不足、20 例（74%）表现状况复杂和 18 例（67%）团队成员之间沟通不足。
博茨瓦纳等中低收入国家的患者预后不良通常归因于资源限制。我们的研究结果表明，虽然此类环境中的住院早期死亡率与败血症性休克等严重表现状况相关，但导致较差预后的主要因素可能是医疗保健提供者和系统因素，而不是缺乏诊断和治疗资源。通过关注提供者教育和流程改进来提高知识、技能和沟通的低成本干预措施可能是降低该环境中住院早期死亡率和改善住院结果的关键。
