Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania’s Lake Zone: protocol for a quasi-experimental study

Alidina, Shehnaz; Kuchukhidze, Salome; Menon, Gopal; Citron, Isabelle; Lama, Tenzing N.; Meara, John G.; Barash, David; Hellar, Augustino; Kapologwe, Ntuli; Maina, Erastus; Reynolds, Cheri; Staffa, Steven J.; Troxel, Alena; Varghese, Asha; Zurakowski, David; Ulisubisya, Mpoki; Maongezi, Sarah

doi:10.1136/bmjopen-2019-031800

Cited by 20 publications

(29 citation statements)

References 59 publications

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“…The third phase involved bimonthly mentorship visits, virtual mentorship through Project ECHO, infrastructure grants up to $10,000 USD, an equipment package, and the Touch Surgery mobile training application. A more detailed description of the intervention is described elsewhere [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…Reaching these case numbers was not feasible within the larger SS2020 effort due to time and Multiple hospital classifications and sizes were used for this study World J Surg resource constraints. A full evaluation protocol of the SS2020 project can be read in Alidina et al 2019 [14]. The details of assumptions for the power calculations can be found in Online Resource 1.…”

Section: Power Calculationmentioning

confidence: 99%

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In‐Hospital Postoperative Mortality Rates for Selected Procedures in Tanzania's Lake Zone

et al. 2020

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Background Postoperative mortality rate is one of six surgical indicators identified by the Lancet Commission on Global Surgery for monitoring access to high-quality surgical care. The primary aim of this study was to measure the postoperative mortality rate in Tanzania’s Lake Zone to provide a baseline for surgical strengthening efforts. The secondary aim was to measure the effect of Safe Surgery 2020, a multi-component intervention to improve surgical quality, on postoperative mortality after 10 months. Methods We prospectively collected data on postoperative mortality from 20 health centers, district hospitals, and regional hospitals in Tanzania’s Lake Zone over two time periods: pre-intervention (February to April 2018) and post-intervention (March to May 2019). We analyzed postoperative mortality rates by procedure type. We used logistic regression to determine the impact of Safe Surgery 2020 on postoperative mortality. Results The overall average in-hospital non-obstetric postoperative mortality rate for all surgery procedures was 2.62%. The postoperative mortality rates for laparotomy were 3.92% and for cesarean delivery was 0.24%. Logistic regression demonstrated no difference in the postoperative mortality rate after the Safe Surgery 2020 intervention. Conclusions Our results inform national surgical planning in Tanzania by providing a sub-national baseline estimate of postoperative mortality rates for multiple surgical procedures and serve as a basis from which to measure the impact of future surgical quality interventions. Our study showed no improvement in postoperative mortality after implementation of Safe Surgery 2020, possibly due to low power to detect change.

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Section: Methodsmentioning

confidence: 99%

Section: Power Calculationmentioning

confidence: 99%

In‐Hospital Postoperative Mortality Rates for Selected Procedures in Tanzania's Lake Zone

et al. 2020

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“…Our data quality assessment was conducted as part of a longitudinal, multi-centered, quasi-experimental study to examine the impact of a multi-component intervention in ten intervention and ten control facilities in Tanzania’s Lake Zone region. The study protocol is published elsewhere [ 14 ]. Briefly, the study included 4 health centers, 11 district hospitals, and 5 regional referral hospitals.…”

Section: Methodsmentioning

confidence: 99%

Assessing completeness of patient medical records of surgical and obstetric patients in Northern Tanzania

Menon

Kuchukhidze

Jumbam

et al. 2020

Global Health Action

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Background: Strengthening surgical services in resource-constrained settings is contingent on using high-quality data to inform decision making at clinical, facility, and policy levels. However, the evidence is sparse on gaps in paper-based medical record quality for surgical and obstetric patients in low-resource settings. Objective: We aim to examine surgical and obstetric patient medical record data quality in health facilities as part of a surgical system strengthening initiative in northern Tanzania. Methods: To measure the incidence of Surgical Site Infections (SSIs), sepsis and maternal sepsis surgical and obstetric inpatients were followed prospectively, over three months in ten primary, district, and regional health facilities in northern Tanzania. Between April 22nd to May 1st, 2018, we retrospectively reviewed paper-based medical records of surgical and obstetric patients diagnosed with SSIs, post-operative sepsis, and maternal sepsis in the three-month follow-up period. A data quality assessment tool with18 data elements related to documentation of SSIs and sepsis diagnosis, their respective symptoms and vital signs, inpatient daily monitoring indicators, and demographic information was developed and used to assess the completeness of patient medical records. Results: Among the 157 patients diagnosed with SSI and sepsis, we found and reviewed 68% of all medical records. Among records reviewed, approximately one third (34%) and one quarter (23%) included documentation of SSI and sepsis diagnoses, respectively. 6% of reviewed records included documentation of all SSI and sepsis diagnoses, symptoms and vital signs, inpatient daily monitoring indicators, and demographic data. Conclusions: Strengthening data quality and record-keeping is essential for surgical team communication, continuity of care, and patient safety, especially in low resource settings where paper-based records are the primary means of data collection. High-quality primary health information provides facilities with actionable data for improving surgical and obstetric care quality at the facility level.

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“…The study was part of a larger prospective longitudinal quasi-experimental Safe Surgery 2020 (SS2020) study which aims to improve the quality of surgical care in Tanzania. Details on this study have been provided elsewhere [23]. Data collection was conducted from 1st February 2018 to 15th June 2018.…”

Section: Samplementioning

confidence: 99%

Surgical referrals in Northern Tanzania: a prospective assessment of rates, preventability, reasons and patterns

Jumbam

Menon

Lama

et al. 2020

BMC Health Serv Res

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Background: An effective referral system is essential for a high-quality health system that provides safe surgical care while optimizing patient outcomes and ensuring efficiency. The role of referral systems in countries with under-resourced health systems is poorly understood. The aim of this study was to examine the rates, preventability, reasons and patterns of outward referrals of surgical patients across three levels of the healthcare system in Northern Tanzania. Methods: Referrals from surgical and obstetric wards were assessed at 20 health facilities in five rural regions prospectively over 3 months. Trained physician data collectors used data collection forms to capture referral details daily from hospital referral letters and through discussions with clinicians and nurses. Referrals were deemed preventable if the presenting condition was one that should be managed at the referring facility level per the national surgical, obstetric and anaesthesia plan but was referred. Results: Seven hundred forty-three total outward referrals were recorded during the study period. The referral rate was highest at regional hospitals (2.9%), followed by district hospitals (1.9%) and health centers (1.5%). About 35% of all referrals were preventable, with the highest rate from regional hospitals (70%). The most common reasons for referrals were staff-related (76%), followed by equipment (55%) and drugs or supplies (21%). Patient preference accounted for 1% of referrals. Three quarters of referrals (77%) were to the zonal hospital, followed by the regional hospitals (17%) and district hospitals (12%). The most common reason for referral to zonal (84%) and regional level (66%) hospitals was need for specialist care while the most common reason for referral to district level hospitals was non-functional imaging diagnostic equipment (28%).

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Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania’s Lake Zone: protocol for a quasi-experimental study

Cited by 20 publications

References 59 publications

In‐Hospital Postoperative Mortality Rates for Selected Procedures in Tanzania's Lake Zone

In‐Hospital Postoperative Mortality Rates for Selected Procedures in Tanzania's Lake Zone

Assessing completeness of patient medical records of surgical and obstetric patients in Northern Tanzania

Surgical referrals in Northern Tanzania: a prospective assessment of rates, preventability, reasons and patterns

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