AFJOG

ORIGINAL RESEARCH ABSTRACT Background: Critical incidents have been reported among the top ten leading causes of morbidity and mortality worldwide. Recently, a renewed focus has been on recognising and identifying critical incidents among gynaecological patients. Accurate reporting and analysis of critical incidents represent a strategy and possible intervention to improve patient safety. Objectives: The aim of the study was to report the incidence rates and describe the nature of critical incidents among gynaecological hospital admissions at Steve Biko Academic (SBAH) and Kalafong Provincial Tertiary Hospital (KPTH) in Gauteng, South Africa. Methods: This was a prospective, descriptive analysis of critical incidents among patients admitted to the gynaecology wards at Steve Biko Academic and Kalafong Provincial Tertiary Hospitals from 1 August 2021 to 30 July 2022. During the daily audit meetings, all gynaecological patients who met the criteria of a critical incident were discussed in detail, and a critical incident form was completed for each case. Descriptive analyses were conducted in Stata 15.0® (StataCorp, 4905 Lakeway Drive, College Station, Texas 77845 USA). Results: There were 3225 patients seen between 1 August 2021 and 31 July 2022. A total of 217 patients met the criteria to be classified as critical incidents, thus giving an overall critical incidence rate of 6.7%. The median age (interquartile range [IQR]) of the patients who suffered critical incidents was 42 (34 – 54) years. The median (IQR) gravidity and parity were 2(1 – 4) and 2(1 – 3), respectively. Over a third, 37% (n = 80), of these patients were HIV positive. Of the 217 patients who met the critical incidents criteria, 78.3% (n = 170) were admitted with the intention of surgical treatment. Most, 54.4% (n = 118) of those patients were elective admissions. The three most prevalent critical incidents were omission of the procedure (46%, n = 107), followed by death (28%, n = 66) and performance of unplanned surgery (12%, n = 27). Lack of theatre time was the most common reason for procedure omission (46%, n = 49). Other reasons, namely lack of blood products (4%, n = 49), SARS-CoV-2 (Covid-19) positive results (3%, n = 7), new HIV diagnosis (2.5%, n = 6), change of management plan (2.5%, n = 6) and patient not fit for anaesthesia (2.5%, n = 6) were the following prevalent causes of omission of procedures. The most common avoidable factors were in the category of admin factors (71%, n = 75). The most common reason in this category was inadequate theatre time (46%, n = 49). Conclusion: Critical incidents are a significant cause of morbidity among gynaecology patients at SBAH and KPTH. A substantial proportion of these critical incidents are avoidable. Keywords: Gynaecology; Critical incidents INTRODUCTION Background Several community-based studies have highlighted that gynaecological morbidity is increasing among middle and low-income countries. 1-3 There has recently been renewed focus on recognising and identifying adverse incidents contributing to gynaecological morbidity. 4-5 Organisational (including administrative or infrastructural) and clinical competencies pertaining to human error have been cited as responsible factors contributing to patient morbidity and mortality. 6 The Canadian Regulation 965 of the Public Hospitals Act defines a critical incident as “Any unintended incident that occurs when a patient receives treatment in the hospital, that results in death, or serious disability, injury or harm to the patient, and does not result primarily from the patient’s underlying medical condition or from a known risk inherent in providing the treatment”. 7 Analysis of the literature shows that critical incidents have been studied in surgical, medical and obstetrics disciplines, with a paucity of data pertaining to gynaecology. 2,5 To further explore underlying issues relating specifically to gynaecological morbidity, a set of critical incident criteria were developed and defined by Lombaard and Pattinson in 2004. 3 These incidents include adverse incidents related to the diagnosis. According to the authors, a critical incident may be defined as “any cause or action that leads to extra morbidity in the patient as well as any intervention that, when it is performed, could lead to serious morbidity or mortality in the gynaecological wards.” Their six-month audit revealed an overall critical incident rate of 5% in the emergency admission group compared to 15% in the elective admission group. 3 Assessment of current clinical practice includes daily morning audits coupled with individual case assessment, review process (identification of condition-specific avoidable and modifiable factors) and, in some units, completion of critical incident data form. 3,8 This process is imperative as audit, feedback and reporting systems remain strategic tools to impact the care of women by healthcare professionals. Literature review Global perspective Several published guidelines exist for the management of pregnant women. These guidelines have been developed gradually and systematically over time with the aim of delivering safe and high-quality care to pregnant women. Critical incidents are increasingly recognised as a source of harm to patients. 4,9 Improving patient safety has become a global priority, and another way to reach this goal is LF Intumu 1 , Z Abdool 1 , LC Snyman 2 1 Department of Obstetrics and Gynaecology, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa 2 Department of Obstetrics and Gynaecology, University of Pretoria and Kalafong Provincial Tertiary Hospital, Pretoria, South Africa CORRESPONDENCE: Dr LF Intumu| Email: fredintu@gmail.com A prospective audit of Gynaecological Critical Incidents in the Tshwane Tertiary Hospital Complex African Journal of Obstetrics and Gynaecology | Volume 1 | Issue 1 | 2023 | 15