Audit of Early Mortality among Patients Admitted to the General Medical Ward at a District Hospital in Botswana

Background: Mortality among adult general medical admissions has been reported to be high across sub-Saharan Africa, yet there is a paucity of literature on causes of general medical inpatient mortality and quality-related factors that may contribute to the high incidence of deaths. Based on a prior...

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Autores principales:	Colleen Kershaw, Margaret Williams, Saikiran Kilaru, Rebecca Zash, Kitenge Kalenga, Felly Masole, Roger Shapiro, Tomer Barak
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2019
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/74fc2665c19246baa7b6e91bf0322502
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spelling	oai:doaj.org-article:74fc2665c19246baa7b6e91bf03225022021-12-02T07:46:08ZAudit of Early Mortality among Patients Admitted to the General Medical Ward at a District Hospital in Botswana2214-999610.5334/aogh.1354https://doaj.org/article/74fc2665c19246baa7b6e91bf03225022019-03-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/1354https://doaj.org/toc/2214-9996Background: Mortality among adult general medical admissions has been reported to be high across sub-Saharan Africa, yet there is a paucity of literature on causes of general medical inpatient mortality and quality-related factors that may contribute to the high incidence of deaths. Based on a prior study at our hospital as well as our clinical experience, death early in the hospitalization is common among patients admitted to the adult medical wards. Objective: Quantify early inpatient mortality and identify factors contributing to early in-hospital mortality of medical patients in a resource-limited hospital setting in Botswana. Methods: Twenty-seven cases of patients who died within 48 hours of admission to the general medical wards at Scottish Livingstone Hospital in Molepolole, Botswana from December 1, 2015–April 25, 2016 were retrospectively reviewed through a modified root cause analysis. Findings: Early in-hospital mortality was most frequently attributed to septic shock, identified in 20 (74%) of 27 cases. The most common care management problems were delay in administration of antibiotics (15, 56%), inappropriate fluid management (15, 56%), and deficient coordination of care (15, 56%). The most common contributing factors were inadequate provider knowledge and skills in 25 cases (93%), high complexity of presenting condition in 20 (74%), and inadequate communication between team members in 18 (67%). Conclusions: Poor patient outcomes in low-and middle-income countries like Botswana are often attributed to resource limitations. Our findings suggest that while early in-hospital mortality in such settings is associated with severe presenting conditions like septic shock, primary contributors to lack of better outcomes may be healthcare-provider and system-factors rather than lack of diagnostic and therapeutic resources. Low-cost interventions to improve knowledge, skills and communication through a focus on provider education and process improvement may provide the key to reducing early in-hospital mortality and improving hospitalization outcomes in this setting.Colleen KershawMargaret WilliamsSaikiran KilaruRebecca ZashKitenge KalengaFelly MasoleRoger ShapiroTomer BarakUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 85, Iss 1 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Colleen Kershaw Margaret Williams Saikiran Kilaru Rebecca Zash Kitenge Kalenga Felly Masole Roger Shapiro Tomer Barak Audit of Early Mortality among Patients Admitted to the General Medical Ward at a District Hospital in Botswana
description	Background: Mortality among adult general medical admissions has been reported to be high across sub-Saharan Africa, yet there is a paucity of literature on causes of general medical inpatient mortality and quality-related factors that may contribute to the high incidence of deaths. Based on a prior study at our hospital as well as our clinical experience, death early in the hospitalization is common among patients admitted to the adult medical wards. Objective: Quantify early inpatient mortality and identify factors contributing to early in-hospital mortality of medical patients in a resource-limited hospital setting in Botswana. Methods: Twenty-seven cases of patients who died within 48 hours of admission to the general medical wards at Scottish Livingstone Hospital in Molepolole, Botswana from December 1, 2015–April 25, 2016 were retrospectively reviewed through a modified root cause analysis. Findings: Early in-hospital mortality was most frequently attributed to septic shock, identified in 20 (74%) of 27 cases. The most common care management problems were delay in administration of antibiotics (15, 56%), inappropriate fluid management (15, 56%), and deficient coordination of care (15, 56%). The most common contributing factors were inadequate provider knowledge and skills in 25 cases (93%), high complexity of presenting condition in 20 (74%), and inadequate communication between team members in 18 (67%). Conclusions: Poor patient outcomes in low-and middle-income countries like Botswana are often attributed to resource limitations. Our findings suggest that while early in-hospital mortality in such settings is associated with severe presenting conditions like septic shock, primary contributors to lack of better outcomes may be healthcare-provider and system-factors rather than lack of diagnostic and therapeutic resources. Low-cost interventions to improve knowledge, skills and communication through a focus on provider education and process improvement may provide the key to reducing early in-hospital mortality and improving hospitalization outcomes in this setting.
format	article
author	Colleen Kershaw Margaret Williams Saikiran Kilaru Rebecca Zash Kitenge Kalenga Felly Masole Roger Shapiro Tomer Barak
author_facet	Colleen Kershaw Margaret Williams Saikiran Kilaru Rebecca Zash Kitenge Kalenga Felly Masole Roger Shapiro Tomer Barak
author_sort	Colleen Kershaw
title	Audit of Early Mortality among Patients Admitted to the General Medical Ward at a District Hospital in Botswana
title_short	Audit of Early Mortality among Patients Admitted to the General Medical Ward at a District Hospital in Botswana
title_full	Audit of Early Mortality among Patients Admitted to the General Medical Ward at a District Hospital in Botswana
title_fullStr	Audit of Early Mortality among Patients Admitted to the General Medical Ward at a District Hospital in Botswana
title_full_unstemmed	Audit of Early Mortality among Patients Admitted to the General Medical Ward at a District Hospital in Botswana
title_sort	audit of early mortality among patients admitted to the general medical ward at a district hospital in botswana
publisher	Ubiquity Press
publishDate	2019
url	https://doaj.org/article/74fc2665c19246baa7b6e91bf0322502
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Audit of Early Mortality among Patients Admitted to the General Medical Ward at a District Hospital in Botswana

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