ABSTRACT
Objective: Sustainability in a QIP is a pivotal domain of quality in healthcare. It induces the need of implementing changes in a QIP which add value to the results. In a secondary level hospital of Qatar, a quality improvement project was proposed to reduce the SSIs from 8.3% in 2013. SSI rates were reduced to 1.47% in 2016. However, it was noted that in women with high risk for wound infection, the SSIs rate increased to 10.71% in the last quarter of 2016. To make the project sustainable, in the second quarter of the year 2017, changes were implemented, and antibiotic prophylaxis was given to high-risk cases and the results were evaluated. Design: Quality Improvement Project (QIP) Methods: PDSA cycle was implemented. All women operated at our hospital by either elective or emergency Cesarean from third quarter of 2017 to 2020 were included. Women who were operated in other facilities with SSIs were excluded. A total of 8372 women were delivered by Cesarean section during the study period. Extended use of antibiotics was implemented for 48 h in patients with high risk of SSI. SSIs rate was considered as the key performance indicator and statistical evaluation (odds' ratio) was carried out using online statistical software. Results: The overall SSIs rate observed after implementation of changes was 1.51%. Significant decrease was noted (3.26% vs. 1.51%) (p < 0.001). In the first quarter of 2017, the SSIs rate was 2.73%. After the completion of 14 quarters of the project in 2020, results were analyzed. In the last two quarters of 2019, a significant decrease in SSIs was noted and the SSIs rate reduced to less than one percent. Due to the COVID-19 pandemic, post-operative wound evaluation was done by telephonic consultation by midwives. During this period the rate of SSIs increased to 2.60% in the last quarter of 2020. However, there was insignificant increase in the annual rate of SSIs (1.8% vs. 1.51%). Face to face appointments were re-started as the cases of COVID-19 decreased in the country in 2021. Conclusion: The project led to a great impact on quality. It reduced the rates of SSRIs significantly. Reduced the duration of hospital stay and the cost of care. It also reduced the re-admissions due to SSIs. This project clearly proves that sustainability improves quality by immediate benefits and motivates changes that redefine value.
ABSTRACT
The history of the world during the pandemic era shows a worse kind of treatment to the effected people. The year 2020 is known as a terrifying year due to pandemics in the world. It badly exposes the healthcare system's weakness especially in the developing countries like Pakistan. Ambulance services played a major role in transporting affected people during pandemics. However, an independent survey shows that around 130 million people have very limited access to these facilities in Pakistan. The majority of the population of Pakistan lives in remote and rural areas and is deprived of these services. In this regard, remote monitoring of patients while they are in transit is very crucial. Considering the importance of providing better healthcare services to patients, we propose a model for remote patient monitoring systems (RPMS) integrated with emergency services in Pakistan. This healthcare model continuously keeps track of people including patients and nearest ambulances (the in-context emergency service and the key resource) for helping patients by transporting them to the appropriate healthcare center, as per needed assistance on the go. It helps reducing response time and yet increasing golden time by directly engaging the ambulance from the nearest location (using spatial and temporal features) and bypassing the call center to save the inevitable consumption of time shattered by conventional method. The represented model may enhance the availability of emergency healthcare facilities by reducing service time and allow efficient use of resources. © 2021 Asian Research Publishing Network (ARPN). All Rights Reserved.