Abstract:
Objectives This study was aimed at piloting a
prospective individual patient database on hospital
deliveries in Colombo, Sri Lanka, and at exploring its use
for developing recommendations for improving quality of
care (QoC).
Design Observational study.
Setting De Soysa Maternity Hospital, the largest referral
hospital for maternity care in Sri Lanka.
Data collection and analysis From July 2015 to June
2017, 150 variables were collected for each delivery
using a standardised form and entered into a database.
Data were analysed every 8months, and the results made
available to local staff. Outcomes of the study included:
technical problems; data completeness; data accuracy;
key database findings; and use of data.
Results 7504 deliveries were recorded. No technical
problem was reported. Data completeness exceeded that
of other existing hospital recording systems. Less than 1%
data were missing for maternal variables and less than
3% for newborn variables. Mistakes in data collection
and entry occurred in 0.01% and 0.09% of maternal
and newborn data, respectively. Key QoC indicators
identified in comparison with international standards
were: relatively low maternal mortality (0.053%); relatively
high maternal near-miss cases (3.4%); high rate of
induction of labour (24.6%), caesarean section (30.0%)
and episiotomy (56.1%); relatively high rate of preterm
births (9.4%); low birthweight rate (16.5%); stillbirth
(0.97%); and of total deaths in newborn (1.98%). Based
on key indicators identified, a list of recommendations
was developed, including the use checklists to standardise
case management, training, clinical audits and more
information for patients. A list of lessons learnt with the
implementation of the data collection system was also
drawn.
Conclusions The study shows that the implemented
system of data collection can produce a large quantity
of reliable information. Most importantly, this experience
provides an example on how database findings can be
used for discussing hospital practices, identifying gaps and
to agree on recommendations for improving QoC.
