Boakye Godfred, Gyedu Adam, Stewart Melissa, Donkor Peter, Mock Charles, Stewart Barclay
Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Ghana Armed Forces, Accra, Ghana.
BMC Health Serv Res. 2021 Jan 13;21(1):66. doi: 10.1186/s12913-021-06063-6.
Injuries are a major public health problem globally. With sound planning and organization, essential trauma care can be reliably provided with relatively low-cost equipment and supplies. However, availability of these resources requires an effective and efficient supply chain and good stock management practices. Therefore, this study aimed to assess trauma care resource-related supply management structures and processes at health facilities in Ghana. By doing so, the findings may allow us to identify specific structures and processes that could be improved to facilitate higher quality and more timely care.
Ten hospitals were purposively selected using results from a previously performed national trauma care capacity assessment of hospitals of all levels in Ghana. Five hospitals with low resource availability and 5 hospitals with high resource availability were assessed using the United States Agency for International Development (USAID) Logistics Indicators Assessment Tool and stock ledger review. Data were described and stock management practices were correlated with resource availability.
There were differences in stock management practices between low and high resource availability hospitals, including frequency of reporting and audit, number of stock-outs on day of assessment (median 9 vs 2 stock-outs, range 3-57 vs 0-9 stock-outs, respectively; p = 0.05), duration of stock-outs (median 171 vs 8 days, range 51-1268 vs 0-182 days, respectively; p = 0.02), and fewer of up-to-date stock cards (24 vs 31 up-to-date stock cards, respectively; p = 0.07). Stock-outs were common even among low-cost, essential resources (e.g., nasal cannulas and oxygen masks, endotracheal tubes, syringes, sutures, sterile gloves). Increased adherence to stock management guidelines and higher percentage of up-to-date stock cards were correlated with higher trauma resource availability scores. However, the variance in trauma resource availability scores was poorly explained by these individual factors or when analyzed in a multivariate regression model (r = 0.72; p value for each covariate between 0.17-0.34).
Good supply chain and stock management practices are correlated with high trauma care resource availability. The findings from this study demonstrate several opportunities to improve stock management practices, particularly at low resource availability hospitals.
伤害是全球主要的公共卫生问题。通过合理的规划和组织，使用成本相对较低的设备和物资就能可靠地提供基本的创伤护理。然而，这些资源的可获取性需要一个有效且高效的供应链以及良好的库存管理实践。因此，本研究旨在评估加纳医疗机构中与创伤护理资源相关的供应管理结构和流程。通过这样做，研究结果可能使我们能够识别出可以改进的特定结构和流程，以促进提供更高质量和更及时的护理。
根据加纳此前对各级医院进行的全国创伤护理能力评估结果，有目的地选择了10家医院。使用美国国际开发署（USAID）物流指标评估工具和库存账本审查，对5家资源可获取性低的医院和5家资源可获取性高的医院进行了评估。对数据进行了描述，并将库存管理实践与资源可获取性进行了关联。
资源可获取性低和高的医院在库存管理实践方面存在差异，包括报告和审计频率、评估当天的缺货数量（中位数分别为9次缺货和2次缺货，范围分别为3 - 57次缺货和0 - 9次缺货；p = 0.05）、缺货持续时间（中位数分别为171天和8天，范围分别为51 - 1268天和0 - 182天；p = 0.02），以及最新库存卡数量较少（分别为24张和31张最新库存卡；p = 0.07）。即使在低成本的基本资源（如鼻导管和氧气面罩、气管内导管、注射器、缝线、无菌手套）中，缺货情况也很常见。对库存管理指南的更高遵循度和更高比例的最新库存卡与更高的创伤资源可获取性得分相关。然而，这些个体因素或在多变量回归模型中进行分析时，对创伤资源可获取性得分的方差解释能力较差（r = 0.72；每个协变量的p值在0.17 - 0.34之间）。
良好的供应链和库存管理实践与高创伤护理资源可获取性相关。本研究结果表明有几个机会可以改进库存管理实践，特别是在资源可获取性低的医院。
