Browsing by Subject "Medical Audit"

Now showing 1 - 3 of 3
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    Open Access
    Complications of tube thoracostomy for chest trauma
    (2009)
    OBJECTIVE: To determine the insertional and positional complications encountered by the placement of intercostal chest drains (ICDs) for trauma and whether further training is warranted in operators inserting intercostal chest drains outside level 1 trauma unit settings. METHODS: Over a period of 3 months, all patients with or without an ICD in situ in the front room trauma bay of Tygerberg Hospital were included in the study. Patients admitted directly via the trauma resuscitation unit were excluded. No long-term infective complications were included. A self-reporting system recorded complications, and additional data were obtained by searching the department's records and monthly statistics. RESULTS: A total of 3989 patients with trauma injuries were seen in the front room trauma bay during the study period; 273 (6.8%) patients with an ICD in situ or requiring an ICD were assessed in the trauma unit and admitted to the chest drain ward; 24 patients were identified with 26 complications relating to the insertion and positioning of the ICD; 22 (92%) of these had been referred with an ICD in situ. An overall complication rate of 9.5% was seen. Insertional complications numbered 7 (27%), with 19 (73%) positional complications. The most common errors were insertion at the incorrect anatomical site, and extrathoracic and too shallow placement (side portal of the drain lying outside the chest cavity). CONCLUSION: Operators at the referral hospitals have received insufficient training in the technique for insertion of ICDs for chest trauma and would benefit from more structured instruction and closer supervision of ICD insertion.
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    Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town
    (2012) Maharaj, Roshen C; Geduld, Heike; Wallis, Lee A
    OBJECTIVES: To determine the current door-to-needle time for the administration of fibrinolytics for acute myocardial infarction (AMI) in emergency centres (ECs) at three hospitals in Cape Town, and to compare it with the American Heart Association/American College of Cardiology (AHA/ACC) recommendation of 30 minutes as a marker of quality of care. METHODS: A retrospective review of case notes from January 2008 to July 2010 of all patients receiving thrombolytics for AMI in the ECs of three Cape Town hospitals. The total door-to-needle time was calculated and patient demographics and presentation, physician qualification, clinical symptomology and reasons for delays in thromobolytic administration were analysed. RESULTS: A total of 372 patients with acute ST elevation myocardial infarction (STEMI) were identified; 161 patients were eligible for the study. The median door-to-needle time achieved was 54 minutes (range 13 - 553 mins). A door-to-needle time of 30 minutes or less was achieved in 33 (20.5%) patients; 51.3% of the patients arrived by ambulance; 34% of patients had a pre-hospital 12-lead ECG; and 88.8% had typical symptoms of myocardial infarction. Medical officers administered thrombolytics to 44.7% of the patients. The predominant infarct location on ECG was inferior (55.9%). CONCLUSION: A significant number of patients were not thrombolysed within 30 minutes of presentation. The lack of senior doctors, difficulty interpreting ECGs, atypical presentations and EC system delays prolonged the door-to-needle time in this study.
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    Fatal outcomes among patients on maintenance haemodialysis in sub-Saharan Africa: a 10-year audit from the Douala General Hospital in Cameroon
    (2016) Kengne, André Pascal
    Abstract Background End-Stage Renal disease (ESRD) is associated with increased morbidity and mortality. We assessed the occurrence, time-trend and determinants of fatal outcomes of haemodialysis-treated ESRD patients over a 10-year period in a major referral hospital in Cameroon. Methods Medical records of ESRD patients who started chronic haemodialysis at the Douala General Hospital between 2002 and 2012 were reviewed. Baseline characteristics and fatal outcomes on dialysis were recorded. Accelerated-failure time and logistic regression models were used to investigate the determinants of death. Results A total of 661 patients with 436 (66 %) being men were included in the study. Mean age at dialysis initiation was 46.3 ± 14.7 years. The median [25 th –75 th percentiles] duration on dialysis was 187 [34–754] days. A total of 297 (44.9 %) deaths were recorded during follow-up with statistical difference over the years (p < 0.0001 for year by year variation) but not in a linear fashion (p = 0.508 for linear trend), similarly in men and women (p = 0.212 for gender*year interaction). The death rate at 12 months of follow-up was 26.8 % (n = 177), with again similar variations across years (p < 0.0001). In all, 34 % of deaths occurred within the first 120 days. Year of study and background nephropathies were the main determinants of mortality, with the combination of diabetes and hypertension conveying a 127 % (95 % CI: 40–267 %) higher risk of mortality, relative to hypertension alone. Conclusion Mortality in dialysis is excessively high in this setting. Because most of these premature deaths are potentially preventable, additional efforts are needed to offset the risk and maximise the benefits from the ongoing investments of the government to defray the cost of haemodialysis. Potential actions include sensitisation of the population and healthcare practitioners, early detection and referral of individuals with CKD; and additional subsidies to support the cost of managing co-morbidities in patients with CKD in general.