A. F. Basmayor1, J. Fissehatsion3, M. V. Sgro1, K. Cook1, A. M. Ergete3, B. W. Bogale3, A. D. Beyene2, B. M. Abebe3, T. Jaraczewski1, C. Dodgion1, K. R. Iverson1 1Medical College Of Wisconsin, Milwaukee, WI, USA 2Addis Ababa University, Addis Ababa, Ethiopia 3Hawassa University Comprehensive Specialized Hospital, Hawassa, SIDAMA, Ethiopia
Introduction:
In 2016, Ethiopia created a national policy aimed at increasing the country’s surgical capacity. This included a set of surgical indicators collected at each hospital, which allows for understanding the current state of surgery and tracking progress towards improving outcomes. A follow-up investigation in 2022 showed persistent gaps in the effectiveness of this data system. This project aims to investigate one of these key surgical indicators, perioperative mortality rate (POMR), in the largest referral hospital in the Sidama region.
Methods:
Perioperative mortality was defined as deaths after major surgery prior to hospital discharge. Number of surgical deaths and surgical volume for the recent reporting year (July 2022 – May 2023) were extracted from ward and ICU registries, major operating room registries, and discharge information. POMR data was compared between the following data sources: 1. paper registries from operating rooms, surgical wards, ICU, 2. aggregate discharge information from the liaison office, 3. monthly indicator reports to the health management information system (HMIS), and 4. reports to the national data collection system (DHIS2). Additionally, qualitative interviews with hospital faculty, staff, and trainees were performed to evaluate current practices and challenges to collecting POMR.
Results:
The aggregate POMR indicator (total number of surgical deaths/total surgical volume) for the yearlong time period was: 1.1% (56/5222) for registries, 0.9% (57/6494) for discharge information, 0.5% (33/6437) for HMIS reports, and 0.6% (35/5935) for DHIS2 reports. Qualitative interviews (n=17) reported regular tracking and review of select perioperative deaths within surgical departments, however many interviewees identified the lack of an electronic system as a significant barrier to accurate data collection. Other proposed solutions included implementing closer monitoring of data quality, providing additional equipment and training for staff on data entry, and promoting timely completion of monthly reports.
Conclusion:
Compared to POMR calculated from registries, numbers aggregated at the hospital level and national reports showed a lower POMR. Patient outcomes in registries that were missing at the time of monthly report submission, and were subsequently filled out at transfer or discharge, likely contributed to this gap in the number of deaths recorded. Minor Ophthalmology cases included in the HMIS and DHIS2 data contributed to the disparity in total surgical volume as compared to the registry data, which was limited to major OR cases. Surveys of healthcare professionals revealed strengths in the current system, including consistent workflow, regular mortality reviews and documentation of perioperative deaths in patient charts. Both quantitative and qualitative findings illustrate the importance of standardizing data entry practices and digitalization of medical records as a potential way forward.