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Outcomes of a multicomponent safe surgery intervention in Tanzania’s Lake Zone: a prospective, longitudinal study

BACKGROUND: Evidence-based strategies for improving surgical quality and patient outcomes in low-resource settings are a priority. OBJECTIVE: To evaluate the impact of a multicomponent safe surgery intervention (Safe Surgery 2020) on (1) adherence to safety practices, teamwork and communication, and...

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Autores principales: Alidina, Shehnaz, Menon, Gopal, Staffa, Steven J, Alreja, Sakshie, Barash, David, Barringer, Erin, Cainer, Monica, Citron, Isabelle, DiMeo, Amanda, Ernest, Edwin, Fitzgerald, Laura, Ghandour, Hiba, Gruendl, Magdalena, Hellar, Augustino, Jumbam, Desmond T, Katoto, Adam, Kelly, Lauren, Kisakye, Steve, Kuchukhidze, Salome, Lama, Tenzing, Lodge, William, Maina, Erastus, Massaga, Fabian, Mazhiqi, Adelina, Meara, John G, Mshana, Stella, Nason, Ian, Reynolds, Chase, Reynolds, Cheri, Segirinya, Hannington, Simba, Dorcas, Smith, Victoria, Strader, Christopher, Sydlowski, Meaghan, Tibyehabwa, Leopold, Tinuga, Florian, Troxel, Alena, Ulisubisya, Mpoki, Varallo, John, Wurdeman, Taylor, Zanial, Noor, Zurakowski, David, Kapologwe, Ntuli, Maongezi, Sarah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240014/
https://www.ncbi.nlm.nih.gov/pubmed/34057187
http://dx.doi.org/10.1093/intqhc/mzab087
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author Alidina, Shehnaz
Menon, Gopal
Staffa, Steven J
Alreja, Sakshie
Barash, David
Barringer, Erin
Cainer, Monica
Citron, Isabelle
DiMeo, Amanda
Ernest, Edwin
Fitzgerald, Laura
Ghandour, Hiba
Gruendl, Magdalena
Hellar, Augustino
Jumbam, Desmond T
Katoto, Adam
Kelly, Lauren
Kisakye, Steve
Kuchukhidze, Salome
Lama, Tenzing
Lodge, William
Maina, Erastus
Massaga, Fabian
Mazhiqi, Adelina
Meara, John G
Mshana, Stella
Nason, Ian
Reynolds, Chase
Reynolds, Cheri
Segirinya, Hannington
Simba, Dorcas
Smith, Victoria
Strader, Christopher
Sydlowski, Meaghan
Tibyehabwa, Leopold
Tinuga, Florian
Troxel, Alena
Ulisubisya, Mpoki
Varallo, John
Wurdeman, Taylor
Zanial, Noor
Zurakowski, David
Kapologwe, Ntuli
Maongezi, Sarah
author_facet Alidina, Shehnaz
Menon, Gopal
Staffa, Steven J
Alreja, Sakshie
Barash, David
Barringer, Erin
Cainer, Monica
Citron, Isabelle
DiMeo, Amanda
Ernest, Edwin
Fitzgerald, Laura
Ghandour, Hiba
Gruendl, Magdalena
Hellar, Augustino
Jumbam, Desmond T
Katoto, Adam
Kelly, Lauren
Kisakye, Steve
Kuchukhidze, Salome
Lama, Tenzing
Lodge, William
Maina, Erastus
Massaga, Fabian
Mazhiqi, Adelina
Meara, John G
Mshana, Stella
Nason, Ian
Reynolds, Chase
Reynolds, Cheri
Segirinya, Hannington
Simba, Dorcas
Smith, Victoria
Strader, Christopher
Sydlowski, Meaghan
Tibyehabwa, Leopold
Tinuga, Florian
Troxel, Alena
Ulisubisya, Mpoki
Varallo, John
Wurdeman, Taylor
Zanial, Noor
Zurakowski, David
Kapologwe, Ntuli
Maongezi, Sarah
author_sort Alidina, Shehnaz
collection PubMed
description BACKGROUND: Evidence-based strategies for improving surgical quality and patient outcomes in low-resource settings are a priority. OBJECTIVE: To evaluate the impact of a multicomponent safe surgery intervention (Safe Surgery 2020) on (1) adherence to safety practices, teamwork and communication, and documentation in patient files, and (2) incidence of maternal sepsis, postoperative sepsis, and surgical site infection. METHODS: We conducted a prospective, longitudinal study in 10 intervention and 10 control facilities in Tanzania’s Lake Zone, across a 3-month pre-intervention period in 2018 and 3-month post-intervention period in 2019. SS2020 is a multicomponent intervention to support four surgical quality areas: (i) leadership and teamwork, (ii) evidence-based surgery, anesthesia and equipment sterilization practices, (iii) data completeness and (iv) infrastructure. Surgical team members received training and mentorship, and each facility received up to a $10 000 infrastructure grant. Inpatients undergoing major surgery and postpartum women were followed during their stay up to 30 days. We assessed adherence to 14 safety and teamwork and communication measures through direct observation in the operating room. We identified maternal sepsis (vaginal or cesarean delivery), postoperative sepsis and SSIs prospectively through daily surveillance and assessed medical record completeness retrospectively through chart review. We compared changes in surgical quality outcomes between intervention and control facilities using difference-in-differences analyses to determine areas of impact. RESULTS: Safety practices improved significantly by an additional 20.5% (95% confidence interval (CI), 7.2–33.7%; P = 0.003) and teamwork and communication conversations by 33.3% (95% CI, 5.7–60.8%; P = 0.02) in intervention facilities compared to control facilities. Maternal sepsis rates reduced significantly by 1% (95% CI, 0.1–1.9%; P = 0.02). Documentation completeness improved by 41.8% (95% CI, 27.4–56.1%; P < 0.001) for sepsis and 22.3% (95% CI, 4.7–39.8%; P = 0.01) for SSIs. CONCLUSION: Our findings demonstrate the benefit of the SS2020 approach. Improvement was observed in adherence to safety practices, teamwork and communication, and data quality, and there was a reduction in maternal sepsis rates. Our results support the emerging evidence that improving surgical quality in a low-resource setting requires a focus on the surgical system and culture. Investigation in diverse contexts is necessary to confirm and generalize our results and to understand how to adapt the intervention for different settings. Further work is also necessary to assess the long-term effect and sustainability of such interventions.
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spelling pubmed-82400142021-06-29 Outcomes of a multicomponent safe surgery intervention in Tanzania’s Lake Zone: a prospective, longitudinal study Alidina, Shehnaz Menon, Gopal Staffa, Steven J Alreja, Sakshie Barash, David Barringer, Erin Cainer, Monica Citron, Isabelle DiMeo, Amanda Ernest, Edwin Fitzgerald, Laura Ghandour, Hiba Gruendl, Magdalena Hellar, Augustino Jumbam, Desmond T Katoto, Adam Kelly, Lauren Kisakye, Steve Kuchukhidze, Salome Lama, Tenzing Lodge, William Maina, Erastus Massaga, Fabian Mazhiqi, Adelina Meara, John G Mshana, Stella Nason, Ian Reynolds, Chase Reynolds, Cheri Segirinya, Hannington Simba, Dorcas Smith, Victoria Strader, Christopher Sydlowski, Meaghan Tibyehabwa, Leopold Tinuga, Florian Troxel, Alena Ulisubisya, Mpoki Varallo, John Wurdeman, Taylor Zanial, Noor Zurakowski, David Kapologwe, Ntuli Maongezi, Sarah Int J Qual Health Care Original Research Article BACKGROUND: Evidence-based strategies for improving surgical quality and patient outcomes in low-resource settings are a priority. OBJECTIVE: To evaluate the impact of a multicomponent safe surgery intervention (Safe Surgery 2020) on (1) adherence to safety practices, teamwork and communication, and documentation in patient files, and (2) incidence of maternal sepsis, postoperative sepsis, and surgical site infection. METHODS: We conducted a prospective, longitudinal study in 10 intervention and 10 control facilities in Tanzania’s Lake Zone, across a 3-month pre-intervention period in 2018 and 3-month post-intervention period in 2019. SS2020 is a multicomponent intervention to support four surgical quality areas: (i) leadership and teamwork, (ii) evidence-based surgery, anesthesia and equipment sterilization practices, (iii) data completeness and (iv) infrastructure. Surgical team members received training and mentorship, and each facility received up to a $10 000 infrastructure grant. Inpatients undergoing major surgery and postpartum women were followed during their stay up to 30 days. We assessed adherence to 14 safety and teamwork and communication measures through direct observation in the operating room. We identified maternal sepsis (vaginal or cesarean delivery), postoperative sepsis and SSIs prospectively through daily surveillance and assessed medical record completeness retrospectively through chart review. We compared changes in surgical quality outcomes between intervention and control facilities using difference-in-differences analyses to determine areas of impact. RESULTS: Safety practices improved significantly by an additional 20.5% (95% confidence interval (CI), 7.2–33.7%; P = 0.003) and teamwork and communication conversations by 33.3% (95% CI, 5.7–60.8%; P = 0.02) in intervention facilities compared to control facilities. Maternal sepsis rates reduced significantly by 1% (95% CI, 0.1–1.9%; P = 0.02). Documentation completeness improved by 41.8% (95% CI, 27.4–56.1%; P < 0.001) for sepsis and 22.3% (95% CI, 4.7–39.8%; P = 0.01) for SSIs. CONCLUSION: Our findings demonstrate the benefit of the SS2020 approach. Improvement was observed in adherence to safety practices, teamwork and communication, and data quality, and there was a reduction in maternal sepsis rates. Our results support the emerging evidence that improving surgical quality in a low-resource setting requires a focus on the surgical system and culture. Investigation in diverse contexts is necessary to confirm and generalize our results and to understand how to adapt the intervention for different settings. Further work is also necessary to assess the long-term effect and sustainability of such interventions. Oxford University Press 2021-05-31 /pmc/articles/PMC8240014/ /pubmed/34057187 http://dx.doi.org/10.1093/intqhc/mzab087 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of International Society for Quality in Health Care. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Research Article
Alidina, Shehnaz
Menon, Gopal
Staffa, Steven J
Alreja, Sakshie
Barash, David
Barringer, Erin
Cainer, Monica
Citron, Isabelle
DiMeo, Amanda
Ernest, Edwin
Fitzgerald, Laura
Ghandour, Hiba
Gruendl, Magdalena
Hellar, Augustino
Jumbam, Desmond T
Katoto, Adam
Kelly, Lauren
Kisakye, Steve
Kuchukhidze, Salome
Lama, Tenzing
Lodge, William
Maina, Erastus
Massaga, Fabian
Mazhiqi, Adelina
Meara, John G
Mshana, Stella
Nason, Ian
Reynolds, Chase
Reynolds, Cheri
Segirinya, Hannington
Simba, Dorcas
Smith, Victoria
Strader, Christopher
Sydlowski, Meaghan
Tibyehabwa, Leopold
Tinuga, Florian
Troxel, Alena
Ulisubisya, Mpoki
Varallo, John
Wurdeman, Taylor
Zanial, Noor
Zurakowski, David
Kapologwe, Ntuli
Maongezi, Sarah
Outcomes of a multicomponent safe surgery intervention in Tanzania’s Lake Zone: a prospective, longitudinal study
title Outcomes of a multicomponent safe surgery intervention in Tanzania’s Lake Zone: a prospective, longitudinal study
title_full Outcomes of a multicomponent safe surgery intervention in Tanzania’s Lake Zone: a prospective, longitudinal study
title_fullStr Outcomes of a multicomponent safe surgery intervention in Tanzania’s Lake Zone: a prospective, longitudinal study
title_full_unstemmed Outcomes of a multicomponent safe surgery intervention in Tanzania’s Lake Zone: a prospective, longitudinal study
title_short Outcomes of a multicomponent safe surgery intervention in Tanzania’s Lake Zone: a prospective, longitudinal study
title_sort outcomes of a multicomponent safe surgery intervention in tanzania’s lake zone: a prospective, longitudinal study
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240014/
https://www.ncbi.nlm.nih.gov/pubmed/34057187
http://dx.doi.org/10.1093/intqhc/mzab087
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