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Publication Type
Report
UWI Author(s)
Author, Analytic
Edson, W; Burkhalter, B; Harvey, S.A; Boucar, M; Hermida, J; Ayabaca, P; Bucagu, M; Gbangbade, S; McCaw-Binns, A
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Author, Monographic
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Report Title
Safe Motherhood Studies-timeliness of Hospital Care for treating obstetric emergencies results from Benin, Ecuador,Jamaica and Rwanda
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Edition
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Author, Subsidiary
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Place of Publication
Washington, D.C.
Publisher Name
USAID by Quality Assurance Project
Date of Publication
2006
Report ID
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Extent of Work
38 p.
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Location/URL
http:; www.qaproject.org/pubs/PDFs/3rdDelay.pdf
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Abstract
More than 500,000 women worldwide die each year from complications related to childbirth. With good quality obstetric care, approximately 90% of these deaths could be averted. This study investigated the timeliness of in-hospital care during labor and delivery in 14 hospitals in Benin, Ecuador, Jamaica, and Rwanda. It measured intervals between critical events and, based on expert opinion, judged the timeliness of those events for cases of obstetric emergencies. the critical events along the continuum of care included arrival at the hospital, initial evaluation by a professional, diagnosis of an obstetric emergency, order of the definitive treatment for the emergency, and administration of the definitive treatment. Obstetric emergencies and their definitive treatments were gleaned from international standards and included oxytocin and blood transfusion for postpartum hemorrhage, anti-hypertensives and anti-convulsants for eclampsia/pre-eclampsia, cesarean section (C-section) for obstructed labor, antibiotics for sepsis, and several treatments for post-abortion complications. Methods: Direct observations of 859 women arriving at the hospital measured the interval from arrival to the professional evaluation. Medical record reviews by experienced obstetricians of 383 cases of obstetric emergencies identified times of critical events from professional evaluation to administration of definitive treatments. the reviewers also made judgements about whether a delay had occurred and the type of delay (i.e., its causes). The times when our selected critical events occurred were in the patient records 61% of the time. Times were less well-documented in Rwanda (31%) than in the other three countries (54-78 %). the professional evaluation time was documented most frequently (81 %), the order and administration times next most frequently (63 %), and the diagnosis time least frequently (35 %). Valid diagnosis-to-treatment were obtained 65% of the time but analysis by emergency and by treatment resulted in small samples in some countries. The intervals between critical events varied widely across cases, diagnoses, facilities, and countries, but some patterns emerged: (1) The interval between arrival and professional evaluation averaged about 30 minutes across all facilities. It was longer on weekdays than on weekends in Benin and Jamaica and longer during the day than at night in most facilities (2) the interval for the diagnosis of an obstetric emergency to the administration of its definitive treatment varied widely by type of emergency, according to data in the medical records. While postpartum hemorrhage and pre-eclampsia/eclampsia were treated on average within two hours of diagnosis, the definitive treatments for sepsis, obstructed labour, and post-abortion complications were not administered until two to six hours after diagnosis on average, probably reflecting the greater urgency of hemorrhage and eclampsia. This interval also sometimes differed widely between countries. For example, the pooled mean for postpartum hemorrhage was longer in Ecuador than in other countries, while for obstructed labour it was longer in Benin (4) Different settings also resulted in different interval lengths. The interval from an order to an administration of a C-Section was lengthy in Ecuador and Benin due to delays at the large reference hospitals and caused by busy operating room suites and personnel during the day. We found that delays were more likely in complex facilities, such as reference hospitals, where personnel or facilities tended to be busier than less complex ones. the obstetricians who reviewed the patient records judged that the professional evaluation was delayed 12% of the time, the diagnosis 14% of the time, and the administration of the definitive treatment 28% of the time. Conclusion: this study was able to define and, with varying degrees of success, to measure the intervals related to the timeliness of care for in-hospital obstetric emergencies, and to identify delays and many causes of delay. Hospitals can monitor some of the critical indicators of timeliness for treating obstetric emergencies using the methods described here. The measurement process could be made simpler and less costly by developing complication-specific abstraction forms for record review. International standards indicating appropriate intervals for treating obstetric emergencies are needed.....
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