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Advancing obstetric and neonatal care in a regional hospital in Ghana via continuous quality improvement
Author(s) -
Srofenyoh Emmanuel,
Ivester Thomas,
Engmann Cyril,
Olufolabi Adeyemi,
Bookman Laurel,
Owen Medge
Publication year - 2012
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2011.08.010
Subject(s) - medicine , case fatality rate , eclampsia , quality management , standardized mortality ratio , emergency medicine , mortality rate , obstetrics , pediatrics , pregnancy , population , service (business) , environmental health , surgery , economy , biology , economics , genetics
Objective To reduce maternal and neonatal death at a large regional hospital through the use of quality improvement methodologies. Methods In 2007, Kybele and the Ghana Health Service formed a partnership to analyze systems and patient care processes at a regional hospital in Accra, Ghana. A model encompassing continuous assessment, implementation, advocacy, outputs, and outcomes was designed. Key areas for improvement were grouped into “bundles” based on personnel, systems management, and service quality. Primary outcomes included maternal and perinatal mortality, and case fatality rates for hemorrhage and hypertensive disorders. Implementation and outcomes were evaluated tri‐annually between 2007 and 2009. Results During the study period, there was a 34% decrease in maternal mortality despite a 36% increase in patient admission. Case fatality rates for pre‐eclampsia and hemorrhage decreased from 3.1% to 1.1% ( P < 0.05) and from 14.8% to 1.9% ( P < 0.001), respectively. Stillbirths were reduced by 36% ( P < 0.05). Overall, the maternal mortality ratio decreased from 496 per 100 000 live births in 2007 to 328 per 100 000 in 2009. Conclusion Maternal and newborn mortality were reduced in a low‐resource setting when appropriate models for continuous quality improvement were developed and employed.