Assessment of quality of care for children in selected hospitals in ...

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Assessment of quality of care for children in selected hospitals in Ghanasurgeries included incision and drainage, hernia repair, hydrocoelectomy, excision of lumps,and repair of lacerations. Circumcision was commonly performed in the hospitals but notdocumented, thus records were not available in most cases. Additional surgeries carried outwere reduction and immobilisation of fractures in one regional hospital, and skingrafting/reconstructive surgery in a district hospital within a buruli ulcer endemic area.Essential drugs, equipment and suppliesThe full complement of essential drugs, equipment and supplies needed for paediatric carewere not available in all the facilities as shown in the table below. In some facilities, drugswere available at the pharmacy but were not found at the emergency area or ward. Alsosome programme drugs, such as anti‐tuberculous drugs, were managed at the DistrictHealth Directorate. Essential equipment and supplies, such as oxygen, nebulizers andglucometers, were not available in some children’s units.The hospital laboratories provided 24 hour support services in all the facilities visited,however some tests, such as cerebrospinal fluid (CSF) microscopy, blood grouping andcross‐matching, were not available in some of the facilities. If a differential diagnosis ofmeningitis was made, there was usually no way of confirming it due to the absence of a CSFmicroscopy test. In the case of one hospital, a private firm provides laboratory services.In most facilities, other emergency laboratory tests, such as haemoglobin, blood film, andgrouping and cross matching, were provided not only during regular business hours, butalso at night, at weekends and during holidays. Most of the laboratory tests were able to bedone within two hours and for inpatients, the results were obtained within 24 hours.Table 2: Availability of drugs, equipment, supplies and laboratory supportNumber of facilities out of 10 found to be:Care assessed Good In need of someimprovementCommentsAvailability of essential drugs 4 6Availability of paediatric equipment 2 8 Infant-sized equipment notavailable in some facilities.Adequate equipment is available inthe emergency area and on theward2 8Essential laboratory tests availableand timely2.3 Emergency care servicesPatient flow4 6 Testing for CSF not available inall facilities.There was no separate outpatient department for children in any of the health facilities andchildren joined adults in the same queue for their hospital cards in all the facilities. Therewere designated health professionals to see sick children at the OPD in three facilities. Twohad paediatricians, while in the other a staff member trained in integrated management ofchildren’s illnesses (IMCI) solely sees children less than five years of age. All sick children atthese three facilities, including emergencies and severely ill children, were received at thesame place in the OPD.Page 6
Assessment of quality of care for children in selected hospitals in GhanaNone of the facilities had the requisite layout, protocols, medications and staff capacity toprovide emergency services according to the standards, as shown in Table 3.Table 3: Management of emergenciesNumber of facilities out of 10 found to be:GoodNeeds to beimprovedLayout and physical structure of the1 9emergency departmentAdequate staffing 0 10CommentsAvailability of essential drugs 5 5Availability of essential laboratory6 4supportAvailability of essential equipment 2 8Practice and case management ofemergency conditions3 7A triaging system was in place in only one hospital where the health‐care assistant is trainedin Emergency Triage and Assessment and Treatment (ETAT). Health workers in otherhospitals identified seriously ill children using a range of systems from a nurse going roundlooking for seriously ill children to announcements through a public address system callingfor mothers with seriously ill children to report at the nurses’ station. In the absence ofproper triaging, seriously ill and emergency patients were missed and had to wait in thequeue to be seen. The exception was those with obvious emergencies, like seizures.Qualified health professionals were always available but most of them have not been trainedin ETAT and therefore do not have adequate skills to manage emergencies. Protocols, or jobaids to guide the management of emergencies, were not available in most of the facilities.The few that were displayed need to be updated and also contained very scanty information.Commonly displayed on walls were memos and notices that were very old, having outlivedtheir usefulness and no longer relevant to the care of sick children. Three facilities had somestaff trained in ETAT, as well as charts and protocols displayed on the walls in the children’sward.Page 7
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