Department of Epidemiology & Public Health, Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Leinster, Ireland
Department of Epidemiology & Public Health, Royal College of Surgeons in Ireland Division of Population Health Sciences, Dublin, Leinster, Ireland.
BMJ Qual Saf. 2021 Dec;30(12):950-960. doi: 10.1136/bmjqs-2020-012751. Epub 2021 Mar 16.
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.
在低收入和中等收入国家，估计有三分之一的临床不良事件发生在非复杂情况下，其中 83%是可以预防的。护理质量差也导致卫生人力、物力和财力的使用效率低下。改善结果和减轻不良事件风险需要有效的监测和质量控制系统。
评估马拉维、坦桑尼亚和赞比亚地区医院（DH）的手术监测和质量控制系统状况。
对 75 家 DH 进行了一项混合方法的横断面研究：马拉维（22 家）、坦桑尼亚（30 家）和赞比亚（23 家）。其中包括问卷调查、访谈和手术室（OT）登记册的目视检查。收集了有关手术活动、流程和结果的监测和质量系统以及感知障碍的数据。
53%（n=40/75）的 DH 使用多个 OT 登记册来记录手术。除了赞比亚标准化的印刷 OT 登记册外，DH 之间的登记册格式（通常是手写书籍）和收集的数据类型各不相同。很少有外科团队对每月报告进行分析。不到 30%的所有调查 DH 使用手术安全检查表（n=22/75），不到 15%（n=11/75）进行手术审核。73%（n=22/30）的坦桑尼亚 DH 和不到一半的马拉维（n=11/22）和赞比亚（n=10/23）DH 进行了手术病例回顾。只有 65%（n=15/23）的赞比亚 DH 汇编了手术发病率和死亡率报告，而在不到三分之一的坦桑尼亚 DH（n=9/30）和马拉维 DH（n=4/22）中报告了这一数据。监测和质量系统报告的障碍包括缺乏正式的指导方针、持续的培训机会以及不足的问责机制。
在所抽样的 DH 中，手术监测和质量控制系统并不标准。需要改进使用的质量措施的标准化；并确保数据的完整性、分析和利用，以改善患者的结果。
