Improving estimation of prevalence of gastrointestinal bleeding and selected predictors of mortality on the medical emergency ward at Mulago hospital.
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Background: Physicians on the gastrointestinal ward of Mulago hospital noted that many patients with gastrointestinal bleeding are transferred to their ward from the emergency ward without adequate resuscitation. They recommended that blood should be ring fenced for patients with gastrointestinal bleeding (GI) on the emergency ward so that urgent resuscitation can be done. There was however no current data on the prevalence of GI bleeding in the emergency ward to provide a guide of how much blood should be ring fenced. This was partly because the medical records are not adequately completed as designed. We thus undertook a study to estimate the prevalence of GI bleeding on the emergency ward by incorporating quality improvement methods in the process of data collection to improve the documentation practice on the Casualty assessment form (CAF). Methods: This was a cross sectional study incorporating quality improvement methods in the process of data collection from medical records, in particular, the CAF for patients attending the emergency ward. Focus group discussions and key informant interviews were conducted to ascertain the causes of inadequate completion of this form. The health care team was educated on documentation of GI bleeding while being assessed weekly for knowledge and practice of completion of the CAF. The filled CAF were assessed for adequate completion while looking out for a documented diagnosis of GI bleeding and selected predictors of mortality so as to determine its‘ prevalence from the proportion of study participants with GI bleeding. Results: The major cause of inadequate completion of the CAF was inadequate supervision of the health care team. The knowledge of the health workers about documentation on the CAF was 71% on average but the practice of completing the CAF remained suboptimal with the highest completion rate being 55.8%. Of the 1881 CAF assessed, 278 had a documented diagnosis of GI bleeding, resulting in a prevalence of 6.8%. Of the patients with GI bleeding, 14.1% of them had age greater than 60 years old, 24.0% had a systolic blood pressure less than 100mmHg and 44.5% had a heart rate greater than 100 beats per minute. Conclusion: Improving the practice of completion of the CAF and other medical records is possible and can be achieved using quality improvement methods that are effective, efficient and sustainable so as to have accurate and reliable data for use for planning purposes so as to xiii improve patient care. The prevalence of GI bleeding on the medical emergency ward of Mulago hospital is high, with 1 in every 15 patients having this condition. Recommendations: We recommend continuous education and supervision of the health care team to have a sustained improvement in completion of the CAF. For GI bleeding patients on the medical emergency ward of Mulago hospital, at least 4 units of blood should be ring-fenced daily for their resuscitation