Quality of Healthcare in Acute Pediatric Care Unit in a Tertiary Hospital in Tanzania: A Case of Muhimbili National Hospital
Quality of Healthcare in Acute Pediatric Care Unit in a Tertiary Hospital in Tanzania: A Case of Muhimbili National Hospital
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DOI：
10.3389/fped.2020.00496
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发表时间：
2020-08-27
影响因子：
2.6
通讯作者：
Sunguya, Bruno F.
中科院分区：
文献类型：
--
作者：
Remtullah, Aleya Z.;Sirili, Nathanael;Sunguya, Bruno F.
背景：重症监护室的护理质量对重症患者，尤其是风险更大的儿童的结局至关重要。虽然证据是混合的，只有少数仍然记录在坦桑尼亚等低收入国家的三级医院的儿童护理质量的作用。因此，本研究评估了坦桑尼亚Muhimbili国立医院急性儿科监护室（APCU）3个月的医疗质量。方法：这项混合方法的横断面研究采用定性和定量的方法收集数据，从107名参与者，包括照顾者的儿童入院，和医疗保健提供者在APCU在MNH。Donabedian模型的组成部分被用来评估护理质量。定量资料采用描述性分析，定性资料采用主题性分析。结果：共有24名（26.7%）在APCU住院的儿童在3个月的数据收集期间死亡。其中，41.7%的患者在入院后24小时内死亡。APCU入院的中位时间为5天。尽管存在上述挑战，但大多数照顾者对所提供的服务质量非常满意34人（37.8%）或满意22人（24.4%）。APCU的物理环境具有管理重症儿童的基本要求，但基础设施不足;医疗保健提供者接受了重症护理培训，并更新了治疗指南等。我们注意到卫生工作者的在职培训不足，反馈过程不足，转诊系统明显延误。结论和建议：虽然四分之一的儿童在MNH的APCU入院死亡，在这个三级转诊医院的整体护理质量是适度的，因为它达到了最低可接受的标准。为了提高护理质量，至关重要的是改善基础设施，更新治疗指南，培训重症护理工作人员，并改善反馈过程，特别是在紧急情况和死亡期间。
Background:Quality of care in a critical care unit is vital for the outcomes of critically ill people and especially children, who are more at risk. Although evidence is mixed, only a handful remains documented about the role of quality of care among children in the context of tertiary hospitals of low-income countries such as Tanzania. This study therefore assessed the quality of healthcare in Acute Pediatric Care Unit (APCU) at Muhimbili National Hospital in Tanzania over 3 months. Methodology:This mixed method cross sectional study employed both qualitative and quantitative approaches to gather data from 107 participants that included caregivers of children admitted, and healthcare providers in APCU at MNH. Components of the Donabedian model were used to assess quality of care. Descriptive analyses was conducted for quantitative data while thematic analyses was conducted for qualitative data. Results:A total of 24 (26.7%) of the children admitted in APCU died in the 3-month period of data collection. Of them, 41.7% died during the first 24 h of admission. The median duration of APCU admission was 5 days. Despite the noted challenges, most of the caregivers were very satisfied 34 (37.8%) or satisfied 22 (24.4%) with the quality of services provided. The physical setting in APCU had the basic requirements for management of critically ill children but was insufficient in infrastructure; healthcare providers trained in critical care and updated treatment guidelines amongst others. We noted inadequacy in on-job training of health workers, feedback process, and obvious delays in the referral system. Conclusions and Recommendations:Although one in four children admitted in the APCU at MNH died, the overall quality of care in this tertiary referral hospital was modest as it achieved the minimum acceptable standards. To enhance quality of care, it is vital to improve infrastructure, update treatment guidelines, train staff in critical care and improve the feedback process especially during emergencies and deaths.