Striving for Performance Excellence: Ten Years’ Experience & Impact of Accreditation on Quality, Safety, and Overall Performance in King Saud University Medical City (KSUMC) – A Mixed-Methods Study

BackgroundThe Kingdom of Saudi Arabia (KSA) has undergone a healthcare system transformation to improve healthcare delivery and quality and central to this is the accreditation for healthcare facilities. Hospitals in KSA have relied on international accreditation bodies and are now shifting to national accreditation boards. The objective of this paper is to assess long-term effects of national and international accreditation through measuring staff perception after ten years of participation in multiple accreditation surveys.MethodsThis mixed-methods study was conducted at the King Saud University Medical City. The quantitative tool was adapted from previous studies and was made available in both English and Arabic. Respondents were asked to evaluate their involvement in accreditation and hospital readiness for another accreditation survey using 11 subscales. ANOVA was used to evaluate differences in mean scores based on level of participation in accreditation surveys. A qualitative interview tool was also used to elicit input from key stakeholders, senior leaders, and managers from the university hospitals. ResultsA total of 630 respondents completed the survey. The subscale on Patient Safety scored highest with an average and those measuring Accreditation Impact, Quality Impact and Quality Management closely followed. ANOVA results showed a significantly increasing mean score with increasing involvement of respondents in accreditation with highest scores observed for the first accreditation survey. Linear regression results showed increases in selected outcomes when with increasing subscale scores for patient satisfaction, management and leadership and others. Findings from the qualitative component showed that accreditation supported improved and sustained quality of care. Despite some differences and challenges in implementing both international and national accreditation standards, there were areas of complementarity which supported quality improvement. Respondents also noted improvements in patient outcomes as a result of participation in accreditation.ConclusionThis study is the first to examine the long-term impact of accreditation over an extended period in KSA. The long-term assessment of accreditation conducted in this study revealed that staff perception about performance was highest during the first cycle and consistently decreased with consequent surveys. The slight and incremental decrease in scale scores reveal that the benefits of accreditation were retained.

Prevalence and Postpartum Screening Practice for Type 2 Diabetes following GDM in King Abdulaziz Medical City: A 3-Years Retrospective Cohort Study

Aim: GDM patients were associated to develop T2DM but mostly failed to undergo screening after delivery. This study aims to examine the practice of T2DM screening and prevalence of developing T2DM among women who had GDM in King Abdulaziz Medical City (KAMC), Saudi Arabia. Methods: Retrospective study involving 642 pregnant women with GDM. Medical records on screenings conducted, delivery mode, GDM and diabetes family history were collected and investigated. Statistical analysis was conducted. Frequencies and percentages were used for categorical variables while means and SD for continuous. Chi-square and t-test were used to establish relationship of categorical and comparing two group means, respectively. Results: Patients were 98.8% Saudi nationals, mean weight, height, parity and number of pregnancies were 76.96 kg, 2.74 m, 3.37 and 1.35, respectively. Majority were obese (56.9%), SVD (56.4%) mode of delivery and good lifestyle (91.4%) as management practice. OGTT was used for screening T2DM with 0 hr fasting and 2-hrs after consuming 75g of glucose, physician ordered 6 weeks after delivery. Only 20% had screening for T2DM and 3.9% developed postpartum diabetes with high number of women not returning for ordered OGTT screening (65.6%). Significant predictors identified were parity and mode of delivery for development of T2DM, while only mode of delivery for both screening for T2DM and management of GDM.Conclusion: Low prevalence of developing T2DM but high number of women failed to follow the ordered OGTT screening. Effort on the implementation of OGTT screening for T2DM needs improvement.

Impact of Ursodeoxycholic Acid in Critically Ill Patients With Sepsis: A Retrospective Study

Background: Using ursodeoxycholic acid (UDCA) in critically ill patients as adjunctive therapy for sepsis/septic shock in neonates and children is controversial, while it has not been extensively investigated in adults. This study aims to assess the effect of UDCA use on the early resolution of sepsis/septic shock in critically ill adult patients. Method: A retrospective study of critically ill adult patients in the intensive care unit (ICU) admitted with sepsis/septic shock at King Abdulaziz Medical City. Based on their usage of UDCA, patients were categorized into two groups. A total of 88 patients were included for analysis after matching, based on severity of illness scores within 24-hours of ICU admission. The primary outcome was to assess the effect of UDCA on the severity and resolution of shock at day three of ICU admission. The secondary outcomes were 30-day in-hospital mortality, mechanical ventilation (MV) duration, and ICU length of stay (LOS). Results: Out of the 88 patients matched, 44 patients (50%) received UDCA during the study period. Using UDCA was neither associated with improvement in Sequential Organ Failure Assessment (SOFA) score ( p-value: 0.32), inotropes/vasopressors requirement ( p-value: 0.79), Glasgow Coma Scale (GCS) ( p-value: 0.59) nor total bilirubin levels ( p-value: 0.79) at day three compared with the control. There was a significant association between using UDCA and improvement in PaO2/FiO2 ratio ( p-value: 0.01) and early extubation at day three ( p-value: 0.04). Conclusion: Using UDCA in critically ill patients with sepsis/septic shock was not associated with improvement in shock severity and resolution. However, patients who received UDCA were more likely to be extubated and not require MV on day three of ICU admission.

Assessment of Factors Associated with Depression and Anxiety Among pwMS in Saudi Arabia

Background. Multiple sclerosis (MS) is an inflammatory chronic disease that is characterized by an increased prevalence of adverse mental health outcomes in patients with MS (pwMS). The main aim of this study is to investigate the factors of depression and anxiety in pwMS in the Kingdom of Saudi Arabia (KSA). Materials and Methods. This is a cross-sectional study conducted in KSA during the period from March to June 2020. Participants were recruited from the Neuroimmunology clinics in King Fahad Medical City (KFMC) and King Saud University medical city (KSUMC)in Riyadh City, KSA. The Hospital Anxiety and Depression Scale (HADS) was used to measure depression and anxiety. Fatigue Severity Scale (FSS) was used to measure fatigue in pwMS. A simple random sampling technique was utilized to select participants and the data were analyzed using SPSS v.24.0. Results. A total of 529 participants participated in this study with a response rate of 53.1%. The prevalences of anxiety and depression were 35.3% and 19.7%, respectively. The findings also revealed that depression was more likely to be significantly affected by being male, low education, unemployment, physical inactivity, and fatigue but the anxiety was significantly affected by region, unemployment, short duration since last MS relapse, physical inactivity, and fatigue. Conclusion. Anxiety and depression are not uncommon in pwMS. Given their impact on the lives of affected patients, early detection and management of these symptoms and their associated factors are crucial.

Multiple Fat- Containing Hepatic Hydatid Cysts: A Case Report in The X- Ray Institute at Medical City Health Directorate in Iraq

Background: Hydatidosis is a zoonotic disease caused by Echinococcus granulosus and Echinococcus multilocularis parasite which is still endemic in many countries all over the world especially in the developing countries. The liver is the primary site to be infested by the parasite with a rate of 60 – 75%. The right lobe of the liver gets infected in about 80% of cases. Hydatid disease of the liver is usually asymptomatic and most cases discovered accidentally on routine clinical or radiological examinations for other illness. Symptoms usually appear in complicated cases either due to rupture, secondary bacterial infection, or due to the large size of the cyst which might cause pain in the right upper quadrant of the abdomen, discomfort, and sometimes swelling. In this case report, we reported the presence of fat globules within the hepatic hydatid cysts which is most probably due to rupture of hepatic hydatid cysts into the biliary tree. Keywords: Hepatic, hydatid cyst, fat globule and CT scan

Tracheotomy Outcomes in 71 COVID-19 Patients: A Multi-Centric Study in Saudi Arabia

Since its outbreak in late 2019, the COVID-19 pandemic has seen a sharp rise in the demand for oxygen and ventilation facilities due to the associated extensive damage that it causes to the lungs. This study is considered the first and largest study in Saudi Arabia to evaluate the outcomes of tracheostomy in intubated COVID-19 patients. This is a retrospective, observational cohort study that was conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Western Region, Saudi Arabia and King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. The findings of the study revealed that seventy-one patients with COVID-19 underwent tracheotomy between 1 March 2020 and 31 October 2020. The average period between intubation and tracheostomy was 9.97 days. Hypertension, diabetes, lung disease and obesity (BMI > 30) were significant risk factors of mortality. The overall 30-day mortality rate was 38.4%.