Comparison of obstetric emergency clinical readiness: A cross-sectional analysis of hospitals in Amhara, Ethiopia.
Comparison of obstetric emergency clinical readiness: A cross-sectional analysis of hospitals in Amhara, Ethiopia.
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DOI：
10.1371/journal.pone.0289496
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
衡量设施管理基本产科急诊的准备情况是降低持续升高的孕产妇死亡率的关键一步。目前，信号功能（SF）是全球衡量设施准备情况的黄金标准，并得到世界卫生组织的认可。示踪物品的存在表明设施是否准备好处理基本紧急情况。然而，研究表明SF可能是一个不完整的指标。临床级联（CC）已经成为一个面向临床的替代测量准备。本研究的目的是确定阿姆哈拉的临床准备和量化之间的关系SF和CC估计的准备。数据于2021年5月通过开放数据工具包（ODK）和KoBo工具包收集。我们调查了卫生系统三级的20家医院。商品被用来创建SF准备的措施（例如，%示踪剂）和CC就绪性。我们计算了SF和CC估计值的差异，并计算了级联中6种紧急情况和3个护理阶段的准备损失。所有六种产科急诊的总体SF估计值比使用CC的估计值高29.6%。与全球模式一致，与人工程序（56.7%准备就绪）相比，医院更愿意提供医疗管理（70.0%准备就绪）。手工操作的SF高估率较高（胎盘滞留和不全流产的SF高估率为33.8%），药物治疗的SF高估率较低（25.3%）。医院对处理滞留胎盘的准备最少（30.0%的机构在治疗阶段准备就绪，0.0%的机构在监测和修改阶段准备就绪），对处理高血压急症的准备最充分（85.0%的机构在治疗阶段准备就绪）。当分析中包括方案时，没有机构准备好监测和修改初始治疗时，临床指征为3种常见的紧急情况-败血症，产后出血和胎盘滞留。我们发现SF和CC准备分类之间存在显著差异。这些设施属于这一差异是没有准备好管理常见的产科急诊，供应管理的员工可能难以确定的需要。未来的研究应探讨修改SF或用新的准备测量取代它的可能性。
Measuring facility readiness to manage basic obstetric emergencies is a critical step toward reducing persistently elevated maternal mortality ratios (MMR). Currently, the Signal Functions (SF) is the gold standard for measuring facility readiness globally and endorsed by the World Health Organization. The presence of tracer items classifies facilities’ readiness to manage basic emergencies. However, research suggests the SF may be an incomplete indicator. The Clinical Cascades (CC) have emerged as a clinically-oriented alternative to measuring readiness. The purpose of this study is to determine Amhara’s clinical readiness and quantify the relationship between SF and CC estimates of readiness. Data were collected in May 2021via Open Data Kit (ODK) and KoBo Toolbox. We surveyed 20 hospitals across three levels of the health system. Commodities were used to create measures of SF-readiness (e.g., % tracers) and CC-readiness. We calculated differences in SF and CC estimates and calculated readiness loss across six emergencies and 3 stages of care in the cascades. The overall SF estimate for all six obstetric emergencies was 29.6% greater than the estimates using the CC. Consistent with global patterns, hospitals were more prepared to provide medical management (70.0% ready) compared to manual procedures (56.7% ready). The SF overestimate was greater for manual procedures 33.8% overall for retained placenta and incomplete abortion) and less for medical treatments (25.3%). Hospitals were least prepared to manage retained placentas (30.0% of facilities were ready at treatment and 0.0% were ready at monitor and modify) and most prepared to manage hypertensive emergencies (85.0% of facilities were ready at the treatment stage). When including protocols in the analysis, no facilities were ready to monitor and modify the initial therapy when clinically indicated for 3 common emergencies—sepsis, post-partum hemorrhage and retained placentas. We identified a significant discrepancy between SF and CC readiness classifications. Those facilities that fall within this discrepancy are unprepared to manage common obstetric emergencies, and employees in supply management may have difficulty identify the need. Future research should explore the possibility of modifying the SF or replacing it with a new readiness measurement.
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DOI：
10.1016/j.ijgo.2006.01.028
发表时间：
2006-06-01
影响因子：
3.8
作者：
Bailey, P;Paxton, A;Fry, D
通讯作者：
Fry, D
影响因子：
34.3
作者：
Say, Lale;Chou, Doris;Alkema, Leontine
通讯作者：
Alkema, Leontine
影响因子：
3.3
作者：
Collender, Guy;Gabrysch, Sabine;Campbell, Oona M. R.
通讯作者：
Campbell, Oona M. R.
影响因子：
--
作者：
Spangler, Sydney A.
通讯作者：
Spangler, Sydney A.
影响因子：
15.8
作者：
Gabrysch S;Civitelli G;Edmond KM;Mathai M;Ali M;Bhutta ZA;Campbell OM
通讯作者：
Campbell OM