Summary
Background
The mortality rate of post-surgical complications in low- and middle-income countries is alarmingly high, particularly in Africa. Each year, over 600,000 individuals lose their lives after surgery, primarily from treatable causes. Despite this situation, a significant number of government priorities and development aid are directed towards infectious diseases, while the quality of care for surgical patients receives minimal attention.
Methods: A set of reliable and evidence-based interventions that includes five sequential care steps was designed to reduce post-surgical mortality rates. The 5Rs framework includes Risk Assessment, Recognize, Respond, Reassess, and Reflect elements. The team utilized this framework to guide their decision-making process and improve patient care in the perioperative setting. The implementation of individual R involved the utilization of the Model for Improvement framework, which requires team establishment, problem analysis, aim setting, change generation, defining progress tracking indicators, and change testing.
Interventions: The facility team implemented a set of reliable and evidence-based interventions known as the “5Rs for Rescue. The 5Rs framework includes Risk Assessment, Recognize, Respond, Reassess, and Reflect. This improvement project focuses on the first R, which is Risk stratification. All adult surgical patients above 18 years of age, with a length of stay (LOS) ranging from at least 24 hours to less than 30 days, were included. The following interventions were implemented: risk identification using ASOS, relaying high-risk status, maintaining high-risk awareness, and conducting weekly compliance audits and reflection meetings.
Results from testing phase in selected hospitals: Improvement team meeting weekly and reviewing improvement activities progress was established and functional. After the improvement project introduced significant strides in selected hospitals, adherence to risk calculations has reached an impressive 90% in these facilities, highlighting its importance as a critical component of the diagnostic process.
Conclusion: Since few intensive care units exist in low-income countries like ours, designing and introducing innovative approaches that pick preventable post-operative complications and deterioration, such as the 5Rs, play a critical role in planning and improving postoperative care.