A root-cause analysis of Maternal Mortality in a tertiary care hospital

Background: Improper drug usages expose patients to drug-related problems (DRPs) and can be the cause of patient morbidity and even mortality, especially frequent in hospitalized patients and pediatric groups. Objective: The objective of the present study was to identify and assess the drug-related problems in the pediatric department of tertiary care hospitals. Methods: The cross-sectional, observational study was carried out for six months included pediatric in-patients of age ≤15 years of either gender in pediatric units of tertiary care hospitals of India. The enrolled pediatric patients were observed for any drug-related problem that were further recorded and classified using the DRP registration format taken from Cipolle et al. The assessment of therapy was done by using positional statements from standard organizations and guidelines. Main outcome measure: Incidences of drug-related problems and their assessment and root cause analysis. Results: A total of 970 DRPs were identified in 296 patients, with an overall incidence of 49.3%. The incidence of DRPs was maximum in the age group of 2-12 years of children (51.2%). Patients who took six or more drugs were around eight (OR:8.41 , 95% CI: 5.22 to 13.55) times more likely to have DRPs compared to those patients who took less than six drugs. The incidences of DRPs were more in patients who were hospitalized for ≥ 7 days. Conclusion: The present study revealed significantly higher incidences of DRPs in hospitalized pediatric patients necessitating the involvement of clinical pharmacists in the pediatric department of tertiary care hospitals.

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Trends and causes of maternal mortality in a tertiary care hospital over five years: 2013-2017

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.4.1091 ◽

2019 ◽

Vol 35 (4) ◽

Author(s):

Sonia Rafiq ◽

Wajeeha Syed ◽

Simi Fayaz Ghaffar

Keyword(s):

Maternal Mortality ◽

Maternal Death ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Maternal Mortality Ratio ◽

Care Hospital ◽

Creative Commons ◽

Increased Risk ◽

Mortality Ratio ◽

Public Health Challenge

Background and Objective: Maternal death measurement is essential to a country’s wellbeing and development status. In emerging countries like Pakistan, it remains an intimidating and failed public health challenge. Objectives of our audit were to estimate trends and causes of maternal demise in Lady Reading Hospital, Peshawar, Pakistan. Methods: Between January 2013 to December 2017, a retrospective study was carried out at Medical Teaching Institute, Lady Reading Hospital, Peshawar. A structured proforma was used to collect data from the medical records. To detect trends in mother demise maternal mortality ratio was calculated for each year and for all five years, Spss version 23 was used for data analysis. Results: In the five-year periods 134 deaths were recorded. The maternal mortality during the study period was 431/100,000 live births. An unstable trend in mortality with two crowning periods in 2013 and 2017 was observed. Hemorrhage persisted as the foremost cause of maternal death over the five years period, accounting for 47.76% deaths followed by hypertension, accounting for 25.37% deaths. An increased risk of 35.08% was observed among women aged 25-29 years, followed by 26.11% in 20-24 years and 23.88% in >30 years. Conclusion: There is a decreasing trend of maternal death from 2013 to 2016 but a slight increase was noted in 2017. Hemorrhage was the top cause responsible for the maternal death. doi: https://doi.org/10.12669/pjms.35.4.1091 How to cite this:Rafiq S, Syed W, Ghaffar SF. Trends and causes of maternal mortality in a tertiary care hospital over five years: 2013-2017. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.1091 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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IMPACT OF GOVERNMENT SCHEMES ON MATERNAL HEALTH: AN OBSERVATIONAL STUDY IN A TERTIARY CARE HOSPITAL IN NORTH INDIA

10.36106/ijar/7302621 ◽

2021 ◽

pp. 63-65

Author(s):

Neena Gupta ◽

Uruj Jahan ◽

Subhashini Singh

Keyword(s):

Maternal Health ◽

Observational Study ◽

Maternal Mortality ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Uttar Pradesh ◽

North India ◽

Care Hospital ◽

Mortality And Morbidity ◽

Maternal Mortality And Morbidity

BACKGROUND: Maternal health is an important aspect for the development of any country in terms of increasing equity and reducing poverty. For reduction of maternal mortality and morbidity Government of India launched National health mission (NHM). Some of the major initiatives under NHM are– ASHA (Accredited Social Health Activist), JSY/JSSK (Janani Suraksha Yojana / Janani Shishu Suraksha Karyakaram), National mobile medical units, National ambulance services. METHODS: A retrospective observational study was performed in department of Obstetrics and Gynaecology, G.S.V.M Medical College, Kanpur, Uttar Pradesh which is a low performing state, during the period of 2018 to 2019. A total of 5134 obstetric patients including 1032 low general condition patients were included over duration of 20 months since January 2018 to august 2019. This observational study collected information regarding number of deliveries in different years in this tertiary care hospital, effect on availability of health facilities and antenatal care to the antenatal women after introduction of JSY, ASHA and ambulance services. CONCLUSIONS: After JSY there is major difference in OPD admission and institutional delivery rate. Ambulance services had major contributory role in reducing maternal mortality and morbidity. There is need to improve performance of ASHA by proper supervision and monitoring.

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Study of maternal mortality in a tertiary care hospital in a tribal KBK area of Odisha, India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201217 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1528

Author(s):

Sasmita Behuria ◽

Jyoti Narayan Puhan ◽

Subhra Ghosh ◽

Bhabani Sankar Nayak

Keyword(s):

Maternal Mortality ◽

Tertiary Care Hospital ◽

Physiological State ◽

Tertiary Care ◽

Obstetric Care ◽

Safe Motherhood ◽

Care Hospital ◽

Maternal Deaths ◽

Live Births ◽

Hypertensive Disorders In Pregnancy

Background: Pregnancy, although being considered a physiological state, carries risk of serious maternal morbidity and at times death. This is due to various complications that may occur during pregnancy, labor, or thereafter. The major causes of maternal mortality are mostly preventable through regular antenatal check-up, proper diagnosis, and management of labor complications. Therefore, the factors at different levels affecting the use of these services need to be clearly understood. The aim is to study the incidence of MMR, assess the epidemiological aspects, causes of maternal mortality and avoidable factors that can prevent maternal deaths.Methods: A retrospective hospital-based study was conducted in obstetrics and gynecology department, SLN MCH, a tertiary care referral hospital in a tribal area of southern Odisha over a period of 2 years from April 2017 to March 2019.Results: A total of 108 deaths were analyzed over 2 years period and MMR was calculated to be 1124/1 lakh live births. Most of the maternal deaths occurred in the age group of 20-24 years (35.1%), majority of maternal deaths were observed in multipara (46.3%), 70.3% deaths occurred within 24 hours of admission. Hypertensive disorders in pregnancy (37%) were the leading direct cause followed by hemorrhage (14.8%) and sepsis (11.1%). Among the indirect causes jaundice (7.4%) and anaemia (3.7%) were the leading cause.Conclusions: MMR in our study was very high as compared to national average of 167/1,00,000 live births, being a tertiary care hospital as most of the patients were referred from peripheral centers. Most maternal deaths are preventable by intensive health education, basic obstetric care for all, strengthening referral and communication system and emphasizing on overall safe motherhood.

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Role of risk factors and socio-economic status in pulmonary tuberculosis: a search for the root cause in patients in a tertiary care hospital, South India

Tropical Medicine & International Health ◽

10.1111/j.1365-3156.2010.02676.x ◽

2010 ◽

Vol 16 (1) ◽

pp. 74-78 ◽

Cited By ~ 27

Author(s):

Soham Gupta ◽

Vishnu Prasad Shenoy ◽

Chiranjay Mukhopadhyay ◽

Indira Bairy ◽

Sethumadhavan Muralidharan

Keyword(s):

Risk Factors ◽

Pulmonary Tuberculosis ◽

South India ◽

Tertiary Care Hospital ◽

Economic Status ◽

Tertiary Care ◽

Care Hospital ◽

Root Cause ◽

Socio Economic Status

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Root cause analysis of laboratory turnaround times for patients in the emergency department

CJEM ◽

10.1017/s1481803500009088 ◽

2004 ◽

Vol 6 (02) ◽

pp. 116-122 ◽

Cited By ~ 9

Author(s):

Christopher M.B. Fernandes ◽

Andrew Worster ◽

Stephen Hill ◽

Catherine McCallum ◽

Kevin Eva

Keyword(s):

Processing Time ◽

Tertiary Care ◽

Root Cause Analysis ◽

Turnaround Time ◽

Time Data ◽

Cause Analysis ◽

Order Processing ◽

Root Cause ◽

Event Times ◽

Causes Of Delays

ABSTRACT Introduction: Laboratory investigations are essential to patient care and are conducted routinely in emergency departments (EDs). This study reports the turnaround times at an academic, tertiary care ED, using root cause analysis to identify potential areas of improvement. Our objectives were to compare the laboratory turnaround times with established benchmarks and identify root causes for delays. Methods: Turnaround and process event times for a consecutive sample of hemoglobin and potassium measurements were recorded during an 8-day study period using synchronized time stamps. A log transformation (ln [minutes + 1]) was performed to normalize the time data, which were then compared with established benchmarks using one-sample t tests. Results: The turnaround time for hemoglobin was significantly less than the established benchmark (n = 140, t = –5.69, p < 0.001) and that of potassium was significantly greater (n = 121, t = 12.65, p < 0.001). The hemolysis rate was 5.8%, with 0.017% of samples needing recollection. Causes of delays included order-processing time, a high proportion (43%) of tests performed on patients who had been admitted but were still in the ED waiting for a bed, and excessive laboratory process times for potassium. Conclusions: The turnaround time for hemoglobin (18 min) met the established benchmark, but that for potassium (49 min) did not. Root causes for delay were order-processing time, excessive queue and instrument times for potassium and volume of tests for admitted patients. Further study of these identified causes of delays is required to see whether laboratory TATs can be reduced.

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Causes of maternal mortality at tertiary care hospital

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170026 ◽

2017 ◽

Vol 6 (2) ◽

pp. 404

Author(s):

Vijayalakshmi G. ◽

Usharani N. ◽

A. A. Khazi

Keyword(s):

Maternal Mortality ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Specific Population ◽

Still Births ◽

Child Bearing ◽

Therapeutic Measures ◽

Laboratory Investigations ◽

Threat To Life

Background: Maternal mortality is a vital index of quality and efficiency of obstetric service, prevailing in a country. Women comprise an important section of any population and during child bearing period, the threat to life is protected by various preventive and therapeutic measures and many a time by surgical intervention.Methods: A thorough analysis of data collected. Information was obtained from case sheets, laboratory investigations. During the present study, total births include live births, still births and deaths due to abortions are also included, since it is ‘one of the important causes of maternal deaths.Results: According to the above table Eclampsia is the main cause of direct death. Out of 25vaginal deliveries 7 cases died due to PPH (26.92%).Conclusions: Maternal Mortality is a global problem every country in the world is facing .We need to target specific interventions for specific population.

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