Criteria-based audit to improve quality of care of foetal distress: standardising obstetric care at a national referral hospital in a low resource setting, Tanzania

Abstract Background There is an urgent need to improve quality of care to reduce avoidable mortality and morbidity from surgical diseases in low- and middle-income countries. Currently, there is a lack of knowledge about how evidence-based health system strengthening interventions can be implemented effectively to improve quality of care in these settings. To address this gap, we have developed a multifaceted quality improvement intervention to improve nursing documentation in a low-income country hospital setting. The aim of this pilot project is to test the intervention within the surgical department of a national referral hospital in Freetown, Sierra Leone. Methods This project was co-developed and co-designed by in-country stakeholders and UK-based researchers, after a multiple-methodology assessment of needs (qualitative, quantitative), guided by a participatory ‘Theory of Change’ process. It has a mixed-method, quasi-experimental evaluation design underpinned by implementation and improvement science theoretical approaches. It consists of three distinct phases—(1) pre-implementation(project set up and review of hospital relevant policies and forms), (2) intervention implementation (awareness drive, training package, audit and feedback), and (3) evaluation of (a) the feasibility of delivering the intervention and capturing implementation and process outcomes, (b) the impact of implementation strategies on the adoption, integration, and uptake of the intervention using implementation outcomes, (c) the intervention’s effectiveness For improving nursing in this pilot setting. Discussion We seek to test whether it is possible to deliver and assess a set of theory-driven interventions to improve the quality of nursing documentation using quality improvement and implementation science methods and frameworks in a single facility in Sierra Leone. The results of this study will inform the design of a large-scale effectiveness-implementation study for improving nursing documentation practices for patients throughout hospitals in Sierra Leone. Trial registration Protocol version number 6, date: 24.12.2020, recruitment is planned to begin: January 2021, recruitment will be completed: December 2021.

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Improving the quality of obstetric care for women with obstructed labour in the national referral hospital in Uganda: lessons learnt from criteria based audit

BMC Pregnancy and Childbirth ◽

10.1186/s12884-016-0949-1 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 8

Author(s):

Herbert Kayiga ◽

Judith Ajeani ◽

Paul Kiondo ◽

Dan K. Kaye

Keyword(s):

Obstetric Care ◽

Referral Hospital ◽

Obstructed Labour ◽

Lessons Learnt ◽

Quality Of Obstetric Care ◽

National Referral Hospital

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Performance of colposcopic scoring by modified International Federation of Cervical Pathology and Colposcopy terminology for diagnosing cervical intraepithelial neoplasia in a low-resource setting

South Asian Journal of Cancer ◽

10.4103/sajc.sajc_302_18 ◽

2019 ◽

Vol 08 (04) ◽

pp. 218-220 ◽

Cited By ~ 3

Author(s):

Prabhakaran Nair Rema ◽

Aleyamma Mathew ◽

Shaji Thomas

Keyword(s):

Cervical Intraepithelial Neoplasia ◽

Scoring Systems ◽

Intraepithelial Neoplasia ◽

International Federation ◽

Screening Tests ◽

Substantial Agreement ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

Abstract Introduction: Colposcopy is a tool to evaluate women with cervical pre-cancer and cancer. To interpret the colposcopic findings, various scoring systems are used but with inter observer variations. To improve the quality of colposcopy, International Federation of Cervical Pathology and Colposcopy (IFCPC) has introduced a colposcopic nomenclature in 2011. Colposcopic scoring helps to select patients who need treatment for cervical intraepithelial neoplasia. Aim of the Study: The study aimed to evaluate the agreement between colposcopic diagnosis with the modified IFCPC terminology and cervical pathology in patients with abnormal screening tests and to assess the utility of this colposcopic scoring system in low resource settings. Methodology: Patients with abnormal screening tests who underwent colposcopic assessment in the department of Gynaecological oncology were included in the study. Colposcopic scoring was done by the modified IFCPC nomenclature. The results were compared with cytology and the final histopathology. Results: 56 patients were included in the study. The colposcopic scoring when compared to histopathology showed agreement in 65.7% which indicated the agreement was substantial and was statistically significant (P = 0.0001). With cytology the colposcopic score showed agreement in 35.6% indicating a fair agreement and this was also statistically significant (P = 0.001). Conclusion: Colposcopic scoring by modified IFCPC 2011 criteria showed substantial agreement with cervical histopathology. Compared to traditional methods, 2011 international terminology of colposcopy could improve colposcopic accuracy.

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Improving Standards of Care in Obstructed Labour: A Criteria-Based Audit at a Referral Hospital in a Low-Resource Setting in Tanzania

PLoS ONE ◽

10.1371/journal.pone.0166619 ◽

2016 ◽

Vol 11 (11) ◽

pp. e0166619 ◽

Cited By ~ 4

Author(s):

Andrew H. Mgaya ◽

Hussein L. Kidanto ◽

Lennarth Nystrom ◽

Birgitta Essén

Keyword(s):

Referral Hospital ◽

Standards Of Care ◽

Low Resource ◽

Obstructed Labour ◽

Resource Setting ◽

Low Resource Setting

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Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-016-1142-2 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 20

Author(s):

Nanna Maaløe ◽

Natasha Housseine ◽

Ib Christian Bygbjerg ◽

Tarek Meguid ◽

Rashid Saleh Khamis ◽

...

Keyword(s):

Quality Of Care ◽

Case Control Study ◽

Case Control ◽

Referral Hospital ◽

Low Resource ◽

Control Study

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PERIOPERATIVE COMPLICATIONS OF RADICAL HYSTERECTOMY AT MOI TEACHING AND REFERRAL HOSPITAL, A LOW RESOURCE SETTING – A 5 YEAR REVIEW

10.26226/morressier.5770e29bd462b80290b4ba84 ◽

2016 ◽

Author(s):

Gregory Ganda

Keyword(s):

Radical Hysterectomy ◽

Perioperative Complications ◽

Referral Hospital ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting

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Perspectives of Nurses About Factors Affecting Quality of Care at the Solomon Islands National Referral Hospital During the 2016-2017 Dengue Outbreak: A Qualitative Study

Asia Pacific Journal of Public Health ◽

10.1177/10105395211036266 ◽

2021 ◽

pp. 101053952110362

Author(s):

Norma Denty Goulolo ◽

Hugo Bugoro ◽

Maxine Whittaker ◽

Sarah Larkins ◽

Humpress Harrington ◽

...

Keyword(s):

Quality Of Care ◽

Nursing Care ◽

Solomon Islands ◽

Referral Hospital ◽

Key Factors ◽

Group Discussions ◽

Factors Affecting ◽

Dengue Outbreak ◽

National Referral Hospital

During the 2016-2017 Solomon Islands dengue outbreak, the National Referral Hospital (NRH) in Honiara was the epicenter for the national response. High-quality nursing care is critical for successful management and this study investigated the factors affecting the quality of nursing care for patients admitted to NRH with dengue. Data were collected using 2 methods: ( a) Focus group discussions with nurses who cared for dengue patients and ( b) a self-administered questionnaire completed by a senior manager. Analysis of qualitative data using a thematic technique found 2 key factors affected care: ( a) training on protocols and guidelines for clinical management and ( b) planning and preparedness of NRH. Quality of care was influenced by lack of basic equipment, transport provided for nursing staff to attend shifts, and confusion between allowances for regular salaried staff and extra staff assisting with the outbreak. Specific attention is needed in future outbreaks to ensure staff understand protocols, follow guidelines, and that adequate equipment is provided.

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