Adverse Events in Hospitalized Obstetric Clients at the Greater Accra (Ridge) Regional Hospital

Abstract

Introduction All over the world, obstetric clients are harmed and even die because of unsafe care. The risk of an obstetric client being hurt or dying when receiving care in hospitals because of an adverse event is greater than the risk of dying in aviation or motor vehicle accidents or by breast cancer. Adverse Events (AEs) in obstetrics unlike in medicine and surgery has not been extensively explored. Similarly, there is still little understanding of the types, factors associated with AEs, frequency of occurrence and the degree of preventability of adverse events at the hospital, even in the advent of clinical audits. The objective of this study was to assess adverse events among hospitalized obstetric clients at the Greater Accra Regional Hospital. Method The medical records/folders of obstetric clients who were on admission from January, 1 to December 31, 2015 at the Greater Accra Regional Hospital were reviewed retrospectively. A total of 1402 folders satisfied the inclusion criteria to determine the proportion of adverse events. A case control study of cases (350) and controls (350) were also selected in the determination of the factors associated with AEs and the degree of preventability. Descriptive and inferential statistics were performed. Models were evaluated for goodness-of-fit measures. The reliability and validity of the scale was also tested using Cronbach’s alpha coefficient. Results The mean gestational age of the clients was 37.4 weeks±4.9 weeks. The major types of AEs were related to surgery while the least type of AEs was related to patient care. The proportion of adverse events was 12.0% in the entire sample of 1402 and more than half (93, 55.4%) of these occurred in the labor & delivery ward. AEs increased with increasing age but was not statistically significant (p=0.879). There was about three-fold (OR=3.35; 95% CI=1.21-9.57) increase in odds of developing adverse events among Antenatal Clinic (ANC) non-attendants and this difference was statistically significant (p=0.044). Similarly, the odds of developing adverse events among obstetric clients who had had a previous surgery and post-term were also high and statistically significant (p<0.05). More than half (208, 64.1%) of the AEs that occurred were preventable. Leadership & governance (inadequate use of protocol and adherence) related factors accounted for more than half (149, 53.2%) of the manner in which AEs among obstetric clients could have been prevented. Conclusion The proportion of adverse events among obstetric clients was high. Patient characteristics such as age, surgical history, number of ANC attendance and gestational age are the main factors associated with adverse events among obstetric clients. The degree of preventability of adverse events was also high due to inadequate intrapartum monitoring and lack of adherence to protocols/guidelines. Key Words Obstetric clients, adverse events, patient safety, quality, health systems building blocks, healthcare, confirmatory factor analysis