AFJOG

ORIGINAL RESEARCH staff working at various healthcare system levels. 20 This is because most of the reasons for avoidable critical incidents in this category were errors in making the diagnosis. Health education would also address the other factors we noted, such as inadequate care provision and substandard patient monitoring. 20, 29 Comparisonofstudyfindingsbyhospital ofadmission The results show that the patient profile and critical incident rates did not differ between the two hospitals. The only notable differences were in the unit of admission as well as the type of admissions. Such differences are explained by the fact that SBAH has more subspecialties when compared to the KPTH. Limitations and strengths of the study This was a prospective descriptive study, and we faced limitations inherent to such studies, such as missing patient files and data variables incompletely filled in. We could not analyse the relationship between age and the incidence of critical incidents. This study may also have been affected by observer bias when it came to analysing patient outcomes. We relied only on critical incidents reported in various records, and we did not go through all the medical records of patients admitted during the study period to find unreported incidents. Existing data shows that critical incident reports have poor quality data compared to reviewing the actual medical records. 17, 25 The study was conducted during the SARS-CoV-2 (Covid-19) pandemic. A positive SARS-CoV-2 status contributed to at least 3% of the procedure cancellations. The impact of SARS-CoV-2 (Covid-19) on the prevalence of critical incidents could not be explored as there was no comparator group (i.e., data collected before the SARS- CoV-2 pandemic). However, despite these limitations, this study provides an important addition to the epidemiology of critical incidents among gynaecology patients. It was also reassuring that our findings were largely comparable to similar studies done in South Africa and globally. The findings from this study, thus, can be generalised to some extent to other healthcare facilities in South Africa and can be used to make recommendations to minimise critical incidents. They also form a basis for comparison for other future studies. CONCLUSION Critical incidents are an important cause of morbidity and harm among gynaecology patients receiving healthcare services at Steve Biko Academic Hospital and Kalafong Tertiary Provincial Hospital. A significant proportion of these critical incidents are avoidable. Therefore, this needs an urgent call to action to adopt measures to eliminate them and improve patient safety. Most reasons for cancelling surgical procedures can be avoided by improving administrative practices. Such measures include standardised booking forms with time allocations per case and predicted operating times to aid in appropriate scheduling of cases; accurate clock- in and clock-out times that are documented; pre-booking to ensure availability of blood products, high care or ICU beds as well as proper patient work up to avoid issues like missing results. Training staff in the importance of accurately recording and reporting critical incidents is needed. Given the general lack of data on critical incidents in the country, more research is needed in this area. One way to achieve this is to create a country-wide universal database platform where all data are captured. Such a substantial data system could provide more robust data that can be used to guide policies and strategies to reduce morbidity and mortality from mainly potentially avoidable adverse incidents. Even though this initiative may require a substantial initial financial outlay, it is plausible that it has a favourable cost-benefit profile as costly procedures and, even to some extent, huge legal bills can be avoided by minimising unnecessary morbidity and mortality from critical incidents. Since incorrect diagnosis and inadequate care contributed to a significant proportion of avoidable critical incidents, the potential impact of adequate training for staff at all levels of care cannot be underestimated.35 Such approaches could minimise critical incidents, improve the quality of care, and limit the number of costly legal action suits against the health departments from disgruntled patients. REFERENCES ¡ § ¬ § ¨ « ¢ § ¦ § ± ² ¨¨ ¨ ¨ ¨ ¨ § ¨ ± ² ± ³²³ § ¬ « ¦ ¦ « ´ µ § ¦ ¦ ´ ¨ ¶ ¨ ¶ ¦ ¡ ¡ ¢ ¨ African Journal of Obstetrics and Gynaecology | Volume 1 | Issue 1 | 2023 | 21