AFJOG

ORIGINAL RESEARCH RATIONALE OF THE STUDY This study sought to describe the nature of the critical incidents (e.g., death, intensive care admission, unplanned surgery etc.) and modifiable factors among women admitted for gynaecological care at Steve Biko Academic (SBAH) and Kalafong Provincial Tertiary Hospitals (KPTH). In addition, the authors aimed to determine the overall critical incident rate and the critical incident rate per condition. MATERIALS AND METHODS This was a 12-month prospective descriptive audit study, from 1 August 2021 until 31 July 2022. This study was conducted at the Department of Obstetrics and Gynaecology at Steve Biko Academic Hospital and Kalafong Provincial Tertiary Hospital. All elective and emergency gynaecologic admissions patients aged at least 18 years, who met the definition of a critical incident and who were willing and able to provide informed consent were eligible for recruitment into the study. Exclusion criteria included patients seen in the gynaecology outpatient department and not admitted, patients younger than 18 years, and those unwilling and unable to provide consent. During the daily Obstetrics and Gynaecology audit meetings, all patients who met the criteria of a critical incident pertaining to gynaecology were discussed in detail, and the critical incident form (see Appendix I) was completed for each case after obtaining informed consent. The principal investigator anonymised all identifiable data before capturing the data into an Excel spreadsheet. Study data was imported from Microsoft Excel to Stata statistical software version 16 (Stata Corp, Texas USA) for analysis. Continuous data were assessed for normality using the Shapiro-Wilk test. Normally distributed continuous data were described as means and standard deviations, whilst non-normal data were described using median and interquartile ranges (IQR). Categorical data were described using frequencies and percentages. A comparison of continuous data was conducted using the Wilcoxon Rank- Sum test. Categorical variables were compared using the Chi-squared or Fischer’s exact test if cell size frequency was less than 5. The significance level (p-value) was set at 0.05. Ethics approval was granted by the Ethics Committee of the Faculty of Health Sciences of the University of Pretoria with reference number 62/2021. RESULTS Overall study results There were 3225 gynaecological admissions between 1 August 2021 and 31 July 2022. A total of 217 patients, 120 from SBAH and 97 from KPTH experienced at least one or more critical incident reports, thus giving an overall critical incidence rate of 6.7%. The critical incident rate of 7.3% for SBAH was not significantly higher than 6.5% for KPTH (p = 0.52). Characteristics of enrolled participants Table 1 below illustrates the basic sociodemographic characteristics of patients with critical events. The median (IQR) age of the patients who suffered critical incidents was 42 (34-54) years. The median gravidity (IQR) was 2 (1-4). The median parity (IQR) was 2 (1-3). Slightly more than half of the patients, n = 120 (54%), were admitted at SBAH, with the remainder being admitted at KTPH, n = 97 (46%). Most of these patients, n = 131 (60%), were gynae-oncology patients, followed by general gynaecology, n = 56 (26%), urogynaecology, n = 20 (9%), reproductive gynaecology, n = 8 (4%) and only two (1%) were obstetric patients. Most of the patients were elective admissions, n = 118 (54.4%), with 57 (26.3%) being oncology patients and 42 (19.3%) being emergencies. The main intention for the admission was to conduct surgical treatment, n = 170 (78.3%). A total of 21 (9.7%) and 26 (12%) were admitted for medical and palliative reasons, respectively. Over a third, n = 80 (37%) of the patients were confirmed HIV positive on admission. Table 1: Sociodemographic characteristics of patients that had critical incidents (n = 217) Description Mean (SD) or median (IQR or n (%) Age years 44.2 (13.8) or 42 (34 – 54) Hospital of admission (n = 217) Steve Biko Academic Hospital 120 (55.3%) Kalafong Tertiary Provincial Hospital 97 (44.7%) Unit of admission (n = 217) Gynae oncology 131 (60.4%) General gynaecology 56 (25.8%) Uro-gynaecology (SBAH) 20 (9.2%) Reproductive gynaecology (SBAH) 8 (3.7%) Obstetrics 2 (0.9%) Type of admission (n = 217) Elective 118 (54.4%) Oncology 57 (26.3%) Emergency 42 (19.3%) Treatment intention (n = 217) Surgical 170 (78.3%) Medical 21 (9.7%) Palliative 26 (12%) Parity 2 (1 – 3) Gravidity 2 (1 – 4) HIV positive 80 (37.3%) SD : Standard Deviation ; IQR: Inter-quartile range. Nature of Critical incidents A total of 235 critical incidents were recorded among 217 patients. Two hundred patients (85%) had one critical incident each while 15% encountered more than one critical incident. As shown in Table 2 below, the three most prevalent critical incidents were omission of the surgical procedure, n = 107 (45.5%), followed by death, n = 66 (28%) and performance of unplanned surgery, n = 27 (11.5%). Sepsis and repeat laparotomy procedures accounted for 3% (n = 6) and 2% (n = 5) of the critical incidents, respectively. African Journal of Obstetrics and Gynaecology | Volume 1 | Issue 1 | 2023 | 17