Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

Byiringiro, Jean Claude; Wong, Rex; Davis, Caroline; Williams, Jeffery O.; Becker, Joseph; Novik, Joseph; Uwineza, Christine; Mukakamali, Chance Delphine; Hategekimana, Théobald; Nyundo, Martin

doi:10.5430/jha.v4n5p47

Cited by 9 publications

(12 citation statements)

References 21 publications

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“…Notably, the KUTH EDs have implemented specialist residency training programs as well as quality improvement projects in recent years and as a result offer a high standard of care and level of organization, which may underestimate logistical issues for other LMIC hospitals. 42,43 Furthermore, the KUTH ED has a reliable electrical power supply with at least one outlet per patient ward. However, as the smartphone requires only 2 h charging per day, this system could still be feasible even in many lower level or rural facilities.…”

Section: Discussionmentioning

confidence: 99%

Validation of a wearable biosensor device for vital sign monitoring in septic emergency department patients in Rwanda

et al. 2019

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Objective: Critical care capabilities needed for the management of septic patients, such as continuous vital sign monitoring, are largely unavailable in most emergency departments (EDs) in low-and middle-income country (LMIC) settings. This study aimed to assess the feasibility and accuracy of using a wireless wearable biosensor device for continuous vital sign monitoring in ED patients with suspected sepsis in an LMIC setting. Methods: This was a prospective observational study of pediatric (!2 mon) and adult patients with suspected sepsis at the Kigali University Teaching Hospital ED. Heart rate, respiratory rate and temperature measurements were continuously recorded using a wearable biosensor device for the duration of the patients' ED course and compared to intermittent manually collected vital signs. Results: A total of 42 patients had sufficient data for analysis. Mean duration of monitoring was 32.8 h per patient. Biosensor measurements were strongly correlated with manual measurements for heart rate (r ¼ 0.87, p < 0.001) and respiratory rate (r ¼ 0.75, p < 0.001), although were less strong for temperature (r ¼ 0.61, p < 0.001). Mean (SD) differences between biosensor and manual measurements were 1.2 (11.4) beats/min, 2.5 (5.5) breaths/min and 1.4 (1.0) C. Technical or practical feasibility issues occurred in 12 patients (28.6%) although were minor and included biosensor detachment, connectivity problems, removal for a radiologic study or exam, and patient/parent desire to remove the device. Conclusions: Wearable biosensor devices can be feasibly implemented and provide accurate continuous heart rate and respiratory rate monitoring in acutely ill pediatric and adult ED patients with sepsis in an LMIC setting.

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Section: Discussionmentioning

confidence: 99%

Validation of a wearable biosensor device for vital sign monitoring in septic emergency department patients in Rwanda

et al. 2019

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“…[23] Similarly, in Rwanda, the application of QI methods in an accident and emergency department successfully eliminated patients boarding in the hallways and reduced foot traffic by 28% without significant financial investment from the hospital. [25] However, the use of QI to reduce elective surgical patient LOS has not been well documented. We selected Rwanda as an ideal site for such a study as the country is currently implementing a national initiative to improve hospital management capacity as part of the Rwanda Human Resources for Health (HRH) project, sponsored by USAID and directed by the Rwandan Ministry of Health.…”

Section: Introductionmentioning

confidence: 99%

A case study: Applying quality improvement methods to reduce pre-operative length of stay in a resource-constrained setting in Rwanda

Ssebuufu

Pawelzik

Megentta

et al. 2015

JHA

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Objective: While several studies have focused on improving the quality of surgery, less attention has been paid to reducing pre-operative delays in care. We undertook a hospital quality improvement (QI) effort to reduce pre-operative delays in a teaching hospital in Rwanda. Without a coordinated admission schedule, many surgical patients arriving at the hospital for admissions were turned away because of unavailable beds. For those admitted for surgery, the pre-operative waits were long.Methods: A pre- and post-intervention study was conducted to examine the impact of a QI effort on two metrics: 1) pre-operative length-of-stay (LOS) for elective surgical patients, and 2) the number of elective surgical patients who were turned away on the scheduled admission date. Intervention: A multi-disciplinary work group utilized a Strategic Problem Solving Approach and implemented a centralized patient wait list and new schedule process utilizing the existing resources available at the hospital.Results: The percentage of elective surgical patients with a pre-operative LOS of more than two days was significantly lower in the post-intervention compared with the pre-intervention period (80% versus 26.8%, p-value < .001). The percentage of scheduled patients who were turned away due unavailable inpatient beds significantly decreased from 63.4% to 5.3%, p-value < .001.Conclusions: By following a methodical strategic problem solving approach, the pre-operative LOS was reduced, elective surgical patients turned away due to unavailable beds was decreased at very low financial cost.

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“…[24,25] There have been an increasing number of hospital quality improvement efforts in Rwanda in the recent years offering specific examples of how these efforts have proved beneficial to the provision of basic care processes, [26] reducing waiting time, [27] documentation compliance, [28] and patient flow. [29] However, few published studies related specifically to reducing IV CRI in Rwanda exist. Accordingly, we sought to examine the impact of a quality improvement project on IV CRI rates in the NICU of a district hospital in Rwanda.…”

Section: Introductionmentioning

confidence: 99%

A quality improvement project to reduce intravenous catheter related infections in the neonatology unit of Kibogora hospital in Rwanda

Nsengiyumva¹,

Wong²,

Adomako³

et al. 2016

JHA

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In developing countries, intravenous (IV) catheter related infections (CRI) rate is generally high. Neonates are more susceptible to develop CRI. We examined the impact of a quality improvement project on IV CRI rates in the neonatal intensive care unit (NICU) of a district hospital in Rwanda. A pre-and post-intervention study was conducted from 2014 to 2016 to evaluate the IV CRI rate and nurses' IV management technique. A written test was administered to evaluate their knowledge on the matter. The intervention had three components: First implementing an IV management policy. Secondly, training staff on the policy and finally, managers provided support and supervision during the change. We measured five indicators: (1) the IV CRI rate; (2) the percentage of nurses who tested ≥ 80% on IV management knowledge; (3) the percentage of IV devices changed following the World Health Organization (WHO) guideline; (4) IV management technique; and (5) the hospital length of stay (LOS). The IV CRI rate reduced from 32.1% to 14.5% (p < .001). The hospital LOS reduced from 15.31 to 7.43 days (p < .001). The compliance of changing IV following WHO guideline increased from 0% to 99% (p < .001); proper IV management technique use increased from 43% to 96% (p < .001); the mean rank of staff on IV management knowledge score significantly increased from 3.5 to 9.5 (p = .004). This project demonstrates that a quality improvement project can help address the IV CRI at very low cost in a resource-challenged setting.

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Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

Cited by 9 publications

References 21 publications

Validation of a wearable biosensor device for vital sign monitoring in septic emergency department patients in Rwanda

Validation of a wearable biosensor device for vital sign monitoring in septic emergency department patients in Rwanda

A case study: Applying quality improvement methods to reduce pre-operative length of stay in a resource-constrained setting in Rwanda

A quality improvement project to reduce intravenous catheter related infections in the neonatology unit of Kibogora hospital in Rwanda

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