Cross-sectional study of surgical quality with a novel evidence-based tool for low-resource settings

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Cross-sectional study of surgical quality with a novel evidence-based tool for low-resource settings


JournalBMJ open quality
Publication date – Mar – 2020
Authors – Lina Roa, Isabelle Citron, Jania A Ramos, Jessica Correia, Berenice Feghali, Julia R Amundson, Saurabh Saluja, Nivaldo Alonso, Rodrigo Vaz Ferreira
Keywordsevidence-based tool, LMICs, low resource setting, surgical quality
Open access – Yes
SpecialityGeneral surgery, Other, Surgical Education
World region South America
Country: Brazil
Language – English
Submitted to the One Surgery Index on May 29, 2020 at 12:36 pm
Abstract:

Background Adverse events from surgical care are a major cause of death and disability, particularly in low-and-middle-income countries. Metrics for quality of surgical care developed in high-income settings are resource-intensive and inappropriate in most lower resource settings. The purpose of this study was to apply and assess the feasibility of a new tool to measure surgical quality in resource-constrained settings.

Methods This is a cross-sectional study of surgical quality using a novel evidence-based tool for quality measurement in low-resource settings. The tool was adapted for use at a tertiary hospital in Amazonas, Brazil resulting in 14 metrics of quality of care. Nine metrics were collected prospectively during a 4-week period, while five were collected retrospectively from the hospital administrative data and operating room logbooks.

Results 183 surgeries were observed, 125 patient questionnaires were administered and patient charts for 1 year were reviewed. All metrics were successfully collected. The study site met the proposed targets for timely process (7 hours from admission to surgery) and effective outcome (3% readmission rate). Other indicators results were equitable structure (1.1 median patient income to catchment population) and equitable outcome (2.5% at risk of catastrophic expenditure), safe outcome (2.6% perioperative mortality rate) and effective structure (fully qualified surgeon present 98% of cases).

Conclusion It is feasible to apply a novel surgical quality measurement tool in resource-limited settings. Prospective collection of all metrics integrated within existing hospital structures is recommended. Further applications of the tool will allow the metrics and targets to be refined and weighted to better guide surgical quality improvement measures.

OSI Number – 20445

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