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

Assessment of quality of care for children in selected hospitals in Ghanamedical and surgical cases were kept in the same room. Some facilities had a few toys forchildren to play with. Physiotherapy and rehabilitation facilities were available in only onefacility. Staff complained that items like toys and crutches were often lost after children weredischarged. Paediatric blood pressure cuffs were only used in one facility where thephysiotherapy unit was privately owned and a patient could be seen for GHC 5.00 a day.2.10 Other hospital wards with childrenOnly two of the facilities admitted children in wards or units other than the children’s ward.Children at these hospitals were either kept in the female ward during peak seasons or inthe maternity ward, since the neonatal units were not well equipped. Very sick neonateswere referred to other hospitals.Staffing was inadequate in all the wards. Midwives on the maternity ward also attended tosick neonates in addition to their mothers, thus compromising the level of monitoring for theneonate and the mother. Supplies and equipment, such as oxygen, were also inadequate andlimited in quantity.2.11 Hospital administrationAvailability of adequate and updated treatment guidelinesRecent paediatric textbooks were found in two of the facilities. In the other facilities, a mix ofcurrent and out‐dated textbooks were found. Standard Treatment Guidelines were common,but there were no complementary wall charts or protocols. Wall charts and protocols onnewborn resuscitation, in particular, were also not seen in most of the facilities. The mostcommonly seen charts were for managing fever, convulsions, and hypoglycaemia. Othersincluded information for managing sickle cell crisis, cerebral malaria, asthma, severeanaemia and diarrhoea.Performance of auditsAudits were organized in various forms in the facilities. A few facilities held audits once amonth, while others held them when “time allow[ed]”. Clinical meetings were not a regularfeature in most of the facilities. In a few facilities, the conduct of mortality audits wasregular, but there was no clarity on the follow‐up actions to address problems identified.Not all the required staff categories participated in the audit meetings.Transport for referralEight of the facilities assessed had ambulances, most of which were in poor condition. Somefacilities relied on the National Ambulance Service, but this was sometimes unreliable. Firstlevelfacilities lacked ambulances.2.12 Access to hospital careReferral by first level or primary health careReferral notes written by first‐level workers did not have IMCI classifications. In somedistricts, medical assistants in surrounding subdistricts had been trained in IMCI, but thePage 20