scholarly journals Protocol for Exploring Effective Clinical Governance Strategies in South Africa’s Eastern Cape and Mpumalanga Provinces

2021 ◽  
Author(s):  
Wezile W. Chitha ◽  
Onke R. Mnyaka ◽  
Danleen J. Hongoro ◽  
Lizo Godlimpi ◽  
Buyiswa Swartbooi ◽  
...  
Keyword(s):  
Health Workers ◽  
Clinical Care ◽  
National Health System ◽  
Tertiary Hospital ◽  
Clinical Governance ◽  
Public Hospitals ◽  
Eastern Cape ◽  
Post Intervention ◽  
Randomised Study ◽  
Regional Hospitals

Abstract Background: Hospitals are an integral part of the national health system. They provide a hub for health services that cannot be provided in the primary care setting, provide facilities for advanced investigation, diagnosis, and treatment, and constitute the platform for training and development of health professionals. However, when inspections were done at public sector facilities in preparation for the implementation of the NHI, the lowest average performance score was in leadership and corporate governance. This study aims to assess the effectiveness of clinical governance interventions in selected public hospitals in South Africa’s Eastern Cape and Mpumalanga provinces. Methods: This will be a cluster randomised study where there will be two intervention sites (a tertiary hospital and a regional hospital) and control sites (non-intervention central and regional hospitals). The intervention will comprise a focused implementation of clinical governance protocols (through training and coaching of hospital management and frontline health workers). There will be a pre-intervention baseline assessment; an assessment immediately at the end of the 12 months long intervention and an assessment at 36 months post-intervention. This builds on existing policy initiatives, quality improvement initiatives and tools. Information will be sourced through six sub-studies – three qualitative and three quantitative. Ethical clearance with reference number: 040/21 has been granted by the Research Ethics Committee of the Faculty of Health Sciences at Walter Sisulu University. Approvals to access the research sites with refence numbers: EC_202106_019 and MP_202106_009 have been granted by the Eastern Cape and Mpumalanga Provincial Health Research Committees respectively.Discussion: There is a need for a deeper understanding of how tertiary and regional hospitals operate, how these hospitals ensure provision of safe high-quality patient-centred clinical care and factors enabling them or hindering them from achieving higher performance. In addition, it is necessary to explore if the performance of the hospitals improves where there is a focused implementation of clinical governance protocols.

From theory to practice of electronic handover

2011 ◽  
Vol 35 (3) ◽  
pp. 384 ◽  
Author(s):  
Sara L. Barnes ◽  
Donald A. Campbell ◽  
Keith A. Stockman ◽  
Dirk Wunderlink
Keyword(s):  
Patient Outcomes ◽  
Allied Health ◽  
Clinical Care ◽  
Hospital Setting ◽  
Work Practice ◽  
Tertiary Hospital ◽  
Multidisciplinary Teams ◽  
Post Intervention ◽  
Serious Adverse Events ◽  
Handover Process

Clinical handover is an essential process occurring at many levels of inpatient care. Multiple studies within a hospital setting have identified that a breakdown in the handover process can lead to poor patient outcomes and serious adverse events. The use of electronic handover tools is an intervention identified to decrease errors in clinical care arising from poor handover practice. An electronic handover tool was implemented in a general medical unit in a metropolitan tertiary hospital setting. The program was written by a Medical Professional who also used the tool. The program was evaluated with a pre- and post-intervention survey within the medical, allied health and nursing staff members of the multidisciplinary teams. The use of the Electronic Handover program resulted in improved satisfaction of the handover process within the medical, nursing and allied health professions. This trial demonstrates that an electronic handover program can be successfully integrated into normal medical work practice, resulting in positive outcomes for a multidisciplinary staff team. Further work is required to determine whether patient outcomes are improved as a result.

scholarly journals Risk perceptions and preventive practices of COVID-19 among healthcare professionals in public hospitals in Ethiopia

2020 ◽  
Author(s):  
Wakgari Deressa ◽  
Alemayehu Worku ◽  
Workeabeba Abebe ◽  
Muluken Gizaw ◽  
Wondwosson Amogne
Keyword(s):  
Risk Perception ◽  
Risk Perceptions ◽  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Preventive Measures ◽  
Health Workers ◽  
Addis Ababa ◽  
Clinical Care ◽  
Public Hospitals ◽  
Preventive Practices

AbstractHealthcare professionals are at higher risk of contracting the novel coronavirus due to their work exposure in the healthcare settings. Practicing appropriate preventive measures to control COVID-19 infection is one of the most important interventions that healthcare workers are expected to use. The aim of this study was to assess the level of risk perception and practices of preventive measures of COVID-19 among health workers in Addis Ababa, Ethiopia. A hospital-based cross-sectional study was conducted from 9th to 26th June 2020 among healthcare professionals working at six public hospitals in Addis Ababa. Data were collected using a self-administered structured questionnaire. Frequency, percentage, and mean were used to summarize the data. A binary logistic regression analyses were performed to identify factors associated with risk perception about COVID-19. A total of 1,134 participants were surveyed. Wearing facemask (93%), hand washing for at least 20 seconds (93%), covering mouth and nose while coughing or sneezing (91%), and avoiding touching eyes, nose, and mouth (91%) were the commonly self-reported preventive practices. About 88% perceived that they were worried about the risk of becoming infected with coronavirus, and majority (91%) worried about the risk of infection to their family. The mean score of overall fear and worry of COVID-19 was 2.37 on a scale of 1 to 3. Respondents who ever provided clinical care to COVID-19 patients were more likely to report fear and worry (adjusted OR=1.34, 95% CI:1.02-1.91), however those who ever participated in Ebola or SARS outbreaks were less likely to report fear and worry due to COVID-19 crisis (adjusted OR=0.66, 95% CI:0.48-0.90). This study has revealed widespread practices of preventive measures and the highest perceived risk of COVID-19 among healthcare workers. Therefore, an effective risk communication intervention should be implemented to ensure the maintenance of appropriate practices during the current COVID-19 pandemic.

scholarly journals Risk perceptions and preventive practices of COVID-19 among healthcare professionals in public hospitals in Ethiopia

2020 ◽  
Author(s):  
Wakgari Deressa ◽  
Alemayehu Worku ◽  
Workeabeba Abebe ◽  
Muluken Gizaw ◽  
Wondwosson Amogne
Keyword(s):  
Risk Perception ◽  
Risk Perceptions ◽  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Preventive Measures ◽  
Health Workers ◽  
Addis Ababa ◽  
Clinical Care ◽  
Public Hospitals ◽  
Preventive Practices

AbstractHealthcare professionals are at higher risk of contracting the novel coronavirus due to their work exposure in the healthcare settings. Practicing appropriate preventive measures to control COVID-19 infection is one of the most important interventions that healthcare workers are expected to use. The aim of this study was to assess the level of risk perception and practices of preventive measures of COVID-19 among health workers in Addis Ababa, Ethiopia. A hospital-based cross-sectional study was conducted from 9th to 26th June 2020 among healthcare professionals working at six public hospitals in Addis Ababa. Data were collected using a self-administered structured questionnaire. Frequency, percentage, and mean were used to summarize the data. A binary logistic regression analyses were performed to identify factors associated with risk perception about COVID-19. A total of 1,134 participants were surveyed. Wearing facemask (93%), hand washing for at least 20 seconds (93%), covering mouth and nose while coughing or sneezing (91%), and avoiding touching eyes, nose, and mouth (91%) were the commonly self-reported preventive practices. About 88% perceived that they were worried about the risk of becoming infected with coronavirus, and majority (91%) worried about the risk of infection to their family. The mean score of overall fear and worry of COVID-19 was 2.37 on a scale of 1 to 3. Respondents who ever provided clinical care to COVID-19 patients were more likely to report fear and worry (adjusted OR=1.34, 95% CI:1.02-1.91), however those who ever participated in Ebola or SARS outbreaks were less likely to report fear and worry due to COVID-19 crisis (adjusted OR=0.66, 95% CI:0.48-0.90). This study has revealed widespread practices of preventive measures and the highest perceived risk of COVID-19 among healthcare workers. Therefore, an effective risk communication intervention should be implemented to ensure the maintenance of appropriate practices during the current COVID-19 pandemic.

scholarly journals Improving TB infection control in a regional hospital in the Eastern Cape, South Africa

2019 ◽  
Vol 8 (1) ◽  
pp. bmjoq-2018-000347 ◽  
Author(s):  
Ilsa Louisa Haeusler ◽  
Felicity Knights ◽  
Vishaal George ◽  
Andy Parrish
Keyword(s):  
South Africa ◽  
Eastern Cape ◽  
Post Intervention ◽  
Hospital Policy ◽  
Staff Members ◽  
Root Cause ◽  
Number Of Patients ◽  
Service Training ◽  
Education And Awareness ◽  
Awareness Raising

This quality improvement (QI) work was carried out in Cecilia Makiwane Hospital (CMH), a regional public hospital in the Eastern Cape, South Africa (SA). SA has among the highest incidence of tuberculosis (TB) in the world and this is a leading cause of death in SA. Nosocomial infection is an important source of TB transmission. Adherence to TB infection prevention control (IPC) measures in the medical inpatient department was suboptimal at CMH. The overall aim of this QI project was to make sustainable improvements in TB IPC. A multidisciplinary team was formed to undertake a root cause analysis and develop a strategy for change. The main barriers to adherence to IPC measures were limited knowledge of IPC methods and stigma associated with TB. Specifically, the project aimed to increase the number of: ‘airborne precaution’ signs placed above patients’ beds, patients correctly isolated and patients wearing surgical face masks. Four Plan-Do-Study-Act cycles were used. The strategy for change involved education and awareness-raising in different formats, including formal in-service training delivered to nurses and doctors, a hospital-wide TB awareness week with engaging activities and competitions, and a World TB Day provincial solidarity march. Data on adherence to the three IPC measures were collected over an 8-month period. Pre-intervention (October 2016), a mean of 2% of patients wore face masks, 22% were correctly isolated and 12% had an airborne precaution sign. Post-intervention (May 2017), the compliance improved to 17%, 50% and 25%, respectively. There was a large variation in compliance to each measure. Improvement was greatest in the number of patients correctly isolated. We learnt it is important to work with, not in parallel to, existing teams or structures during QI work. On-the-ground training of nurses and clinicians should be undertaken alongside engagement of senior staff members and managers. This improves the chance of change being adopted into hospital policy.

scholarly journals Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kirsten Austad ◽  
Michel Juarez ◽  
Hannah Shryer ◽  
Patricia L. Hibberd ◽  
Mari-Lynn Drainoni ◽  
...  
Keyword(s):  
Health Workers ◽  
Positive Impact ◽  
Qualitative Evaluation ◽  
Obstetric Care ◽  
Hospital Staff ◽  
Public Hospitals ◽  
Future Research ◽  
Care Seeking ◽  
Structured Interviews ◽  
The Impact

Abstract Background Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. Methods We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. Results Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. Conclusions Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.

scholarly journals Proposal of a clinical care pathway for quality and safe management of headache patients: a consensus study report

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037190
Author(s):  
Julio Pascual ◽  
Patricia Pozo-Rosich ◽  
Irene Carrillo ◽  
Sandra Rodríguez-Justo ◽  
Dolores Jiménez-Hernández ◽  
...  
Keyword(s):  
Care Pathway ◽  
Clinical Care ◽  
National Health System ◽  
Diagnostic Errors ◽  
Healthcare Management ◽  
Care Process ◽  
Quality And Safety ◽  
Clinical Safety ◽  
Safety Standards ◽  
Headache Patients

BackgroundHeadache is one of the most prevalent and disabling conditions. Its optimal management requires a coordinated and comprehensive response by health systems, but there is still a wide variability that compromises the quality and safety of the care process.PurposeTo establish the basis for designing a care pathway for headache patients through identifying key subpathways in the care process and setting out quality and clinical safety standards that contribute to providing comprehensive, adequate and safe healthcare.MethodA qualitative research study based on the consensus conference technique. Eleven professionals from the Spanish National Health System participated, seven of them with clinical experience in headache and four specialists in healthcare management and quality. First, identification of the key subpathways in the care process for headache, barriers/limitations for optimal quality of care, and quality and safety standards applied in each subpathway. Second, two consecutive consensus rounds were carried out to assess the content of the subpathway level descriptors, until the expert agreement was reached. Third, findings were assessed by 17 external healthcare professionals to determine their understanding, adequacy and usefulness.ResultsSeven key subpathways were identified: (1) primary care, (2) emergency department, (3) neurology department, (4) specialised headache unit, (5) hospitalisation, (6) outpatients and (7) governance and management. Sixty-seventh barriers were identified, the most frequent being related to diagnostic errors (36,1%), resource deficiency (25%), treatment errors (19,4%), lack of health literacy (13,9%) and inadequate communications with care transitions (5,6%). Fifty-nine quality and 31 safety standards were defined. They were related to evaluation (23.3%), patient safety (21.1%), comprehensive care (12.2%), treatment (12.2%), clinical practice guidelines (7.8%), counselling (6.7%), training (4.4%) and patient satisfaction (3.3%).ConclusionsThis proposal incorporates a set of indicators and standards, which can be used to define a pathway for headache patients and determine the levels of quality.

Evaluating the feasibility and efficacy of the Amsterdam memory and attention training for children (Amat-c) following acquired brain injury (ABI): protocol for a pilot study with online clinician support

2021 ◽  
pp. 1-12
Author(s):  
Cathy Catroppa ◽  
Edith Botchway ◽  
Nicholas P. Ryan ◽  
Vicki Anderson ◽  
Elle Morrison ◽  
...  
Keyword(s):  
Brain Injury ◽  
Repeated Measures ◽  
Clinical Care ◽  
Acquired Brain Injury ◽  
Attention Training ◽  
Control Group ◽  
Attention And Memory ◽  
Post Intervention ◽  
Memory And Attention ◽  
Clinician Support

Abstract Background: Attention and memory deficits are common following paediatric acquired brain injury (ABI). However, there are few evidence-based interventions to improve these domains and benefit the everyday life of children post-injury. The Amsterdam Memory and Attention Training for children (Amat-c) has been translated from Dutch to English and shown to improve attention and memory skills in children following ABI. This protocol describes a study to expand accessibility of the program by using online, clinician-supported delivery with children post-ABI. Method/design: The study is a randomized controlled trial. Participants will be 40 children aged 8–16 a minimum of one-year post-ABI. Participants in the treatment group will complete 18 weekly sessions of the Amat-c program with weekly online clinician support. Participants in the active-control group will be administered ABI psychoeducation via a booklet for parents, with weekly online clinician contact. Attention and memory will be assessed at three time points up to six months post-intervention. Results: Analysis will be repeated measures multivariate planned comparisons; using the Statistical Package for the Social Sciences (IBM SPSS Statistics) General Linear Model procedure will compare pre- and post-intervention and six-month follow-up outcomes. Discussion: If shown efficacious in improving attention and memory, our team will then take a key role in implementing Amat-c into clinical care.

Medical students’ perception of sexual orientation in Sagamu, southwestern Nigeria: implications for access to HIV care

2018 ◽  
Vol 11 (5) ◽  
pp. 347-355 ◽  
Author(s):  
Oluwafolahan Oluwagbemiga Sholeye ◽  
Victor Jide Animasahun ◽  
Abimbola A. Oyelekan
Keyword(s):  
Sexual Orientation ◽  
Medical Students ◽  
Health Workers ◽  
Medical Curriculum ◽  
Public Hospitals ◽  
Hiv Care ◽  
Southwestern Nigeria ◽  
Cross Sectional ◽  
Content Type ◽  
Sex With Men

Purpose The prevalence of Human Immunodeficiency Virus (HIV) is about four times higher among individuals with same-sex orientation as against the general population. This may be partly due to judgmental, heteronormative attitudes among health workers, thereby affecting access to care. Therefore, the purpose of this paper is to assess the perception of final-year medical students of Olabisi Onabanjo University, Nigeria on sexual orientation and its implications on access to HIV care and support services. Design/methodology/approach A cross-sectional descriptive study was conducted among final-year medical students. Data were collected using an interviewer-administered questionnaire and analyzed using SPSS 20. Relevant descriptive and inferential statistics were calculated. Participation was fully voluntary. Findings More males (70 percent) were aware of the concept of sexual orientation than females (60.4 percent). Most (94 percent) males and all female respondents felt homosexuality was against the order of nature. More males (76 percent) than females (62.3 percent) felt men having sex with men and homosexuality were synonymous. More females (50.9 percent) than males (48 percent) felt gay doctors should not be employed in public hospitals. Originality/value Respondents had a poor perception of sexual orientation and there were no significant differences between genders. This could contribute to existing stigmatization against individuals with minority sexual orientations. It should be addressed in the medical curriculum.

scholarly journals Improving appropriateness of oxygen saturation monitoring in paediatric patients with acute respiratory illness: a QI initiative

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e15-e15
Author(s):  
Brigitte Parisien ◽  
Daryl Cheng ◽  
Maria Marano ◽  
Julie Johnstone ◽  
Nicole Carmichael ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximetry ◽  
Nursing Staff ◽  
Visual Cues ◽  
Clinical Care ◽  
Respiratory Illness ◽  
Appropriate Use ◽  
Post Intervention ◽  
Prolonged Length ◽  
Paediatric Patients

Abstract BACKGROUND Oxygen saturation monitoring (OSM) is a key aspect of clinical care in paediatric patients with acute respiratory disease. It is commonplace in the assessment of children with bronchiolitis, asthma and pneumonia and serves as a proxy for illness severity. However, there is a paucity of standardized guidelines around appropriate pulse oximetry and OSM use in these patients. Some preliminary evidence shows that intermittent pulse oximetry is as safe as continuous oximetry monitoring in children with bronchiolitis. Furthermore, inappropriate OSM may lead to overdiagnosis and overtreatment of mild hypoxia with no demonstrable clinical improvement and therefore contribute to prolonged length of stay. OBJECTIVES As part of The Choosing Wisely campaign, our aim is to increase the appropriate use of OSM in paediatric inpatients with asthma, bronchiolitis or pneumonia in our center to 90% by April 2018. DESIGN/METHODS Appropriate monitoring is defined as intermittent OSM when a patient is off oxygen for >2 hours and continuous OSM whilst the patient is receiving supplemental oxygen. A 4 week pre-intervention baseline chart review showed 62% (23/37) had appropriate OSM. Series of interventions along the hierarchy of effectiveness were then chosen to improve the main outcome measure: • Educational sessions oriented at medical and nursing staff were provided to guide evidence-based practice and to reinforce the use of specific orders around OSM; • Visual cues were used in strategic locations to remind medical staff of appropriate OSM and to prompt discussion during ward rounds; • Weekly reminders and performance updates were displayed and electronically circulated to medical and nursing staff. Post-intervention data collection occurred via convenience sampling by project leaders from December 2017 to April 2018. A PDSA cycle approach was used to modify interventions. RESULTS OSM appropriateness increased to 78% (56/72) in the first 4 weeks post-initial interventions. There were no negative impacts on balancing measures. We anticipate an ongoing graded increase in appropriateness across the study period triggered by collective staff awareness and synergistic interventions. CONCLUSION This QI initiative will improve the appropriate use of OSM in patients admitted for bronchiolitis, pneumonia or asthma at our paediatric tertiary hospital without increasing the number of patient safety events or admissions to the intensive care unit. Further interventions are planned to ensure greater uptake and sustainability.

scholarly journals Backstreet abortion: Women’s experiences

Curationis ◽  
1997 ◽  
Vol 20 (2) ◽  
Author(s):  
F. Makorah ◽  
K. Wood ◽  
R. Jewkes
Keyword(s):  
Descriptive Study ◽  
Induced Abortion ◽  
Public Hospitals ◽  
Western Cape ◽  
Eastern Cape ◽  
Personal Experiences ◽  
Induced Abortions ◽  
Experiences Of Women ◽  
Depth Interviews ◽  
Induce Abortion

This was a descriptive study aimed at exploring the personal experiences of women who induce abortion and the circumstances surrounding induced abortion. The study was conducted in six public hospitals in four different provinces: Baragwanath (Gauteng), Groote Schuur and Tygerberg (Western Cape), King Edward and R.K. Khan (Kwa-Zulu/Natal) and Livingstone (Eastern Cape). In-depth interviews were conducted with 25 African, Indian and Coloured women admitted to the hospitals following backstreet abortions. The study gave women the opportunity to "speak for themselves" about "why" and "how" and the context in which the unscfe induced abortions occurred

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