Iram Fatima1, Ayesha Humayun2, Muhammad Imran Anwar3, Muhammad Shafiq1. 1. Institute of Quality and Technology Management, University of the Punjab at Khayaban-e-Jamia Punjab, Lahore, Pakistan. 2. Department of Public Health and Community Medicine, Federal Postgraduate Medical Institute & Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Medical Complex, Khayaban-e-Jamia Punjab, Lahore, Pakistan. 3. Department of Surgery, Federal Postgraduate Medical Institute & Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Medical Complex, Khayaban-e-Jamia Punjab, Lahore, Pakistan.
Abstract
OBJECTIVE: To explore the extent of adherence to surgical quality standards and areas of improvement. DESIGN: Multi-method case study was done. Assessment of observed/actual and self-reported adherence to quality standards in surgical care was done on WHO's safe-surgery checklist. Client satisfaction through exit interviews assessed of all operated during 1 month. Semi-structured interviews of key informants were conducted to identify areas of improvements in surgical care in this hospital. SETTING: Conducted in a tertiary care teaching hospital in Lahore, Pakistan. PARTICIPANTS: Out of all 154 patients during 1 month were admitted with indications for surgery and 35.71% patients gave consent and participated in the study. OUTCOME MEASURE: Actual and reported adherence data were categorized in excellent, good, satisfactory and poor adherence to standards. For in-depth interviews, themes were identified from textual data. RESULTS: Overall activities in surgical department were performed well, patients were satisfied and hospital surgical mortality rate was zero but infection control measures needs attention and these practices were found poor with high re-operation and re-admissionrate (P-value < 0.001). Adherence to standards of surgical quality was inadequate in pre-operative, operative and post-op steps as assessed on the checklist but actual adherence was different from reported adherence by surgical care providers. CONCLUSION: This case study shows a complete picture of surgical care quality in a hospital of Pakistan. Discrepancy between perceived/reported adherence and actual practice was found. Patients' satisfaction is not a reliable outcome measure of surgical care quality.
OBJECTIVE: To explore the extent of adherence to surgical quality standards and areas of improvement. DESIGN: Multi-method case study was done. Assessment of observed/actual and self-reported adherence to quality standards in surgical care was done on WHO's safe-surgery checklist. Client satisfaction through exit interviews assessed of all operated during 1 month. Semi-structured interviews of key informants were conducted to identify areas of improvements in surgical care in this hospital. SETTING: Conducted in a tertiary care teaching hospital in Lahore, Pakistan. PARTICIPANTS: Out of all 154 patients during 1 month were admitted with indications for surgery and 35.71% patients gave consent and participated in the study. OUTCOME MEASURE: Actual and reported adherence data were categorized in excellent, good, satisfactory and poor adherence to standards. For in-depth interviews, themes were identified from textual data. RESULTS: Overall activities in surgical department were performed well, patients were satisfied and hospital surgical mortality rate was zero but infection control measures needs attention and these practices were found poor with high re-operation and re-admissionrate (P-value < 0.001). Adherence to standards of surgical quality was inadequate in pre-operative, operative and post-op steps as assessed on the checklist but actual adherence was different from reported adherence by surgical care providers. CONCLUSION: This case study shows a complete picture of surgical care quality in a hospital of Pakistan. Discrepancy between perceived/reported adherence and actual practice was found. Patients' satisfaction is not a reliable outcome measure of surgical care quality.
Authors: Mohammad Ashraf; Usman Ahmad Kamboh; Muhammad Asif Raza; Muhammad Irfan Khan; Kashif Ali Sultan; Nabeel Choudhary; Syed Shahzad Hussain; Naveed Ashraf Journal: Asian J Neurosurg Date: 2022-06-10