title: Quality of surgical care in hospitals providing internship training in Kenya: a cross sectional survey.
abstract: OBJECTIVE
  To evaluate services in hospitals providing internship training to graduate doctors in Kenya.
  
  
  METHODS
  A survey of 22 internship training hospitals was conducted. Availability of key resources spanning infrastructure, personnel, equipment and drugs was assessed by observation. Outcomes and process of care for pre-specified priority conditions (head injury, chest injury, fractures, burns and acute abdomen) were evaluated by auditing case records.
  
  
  RESULTS
  Each hospital had at least one consultant surgeon. Scheduled surgical outpatient clinics, major ward rounds and elective (half day) theatre lists were provided once per week in 91%, 55% and 9%, respectively. In all other hospitals, these were conducted twice weekly. Basic drugs were not always available (e.g. gentamicin, morphine and pethidine in 50%, injectable antistaphylococcal penicillins in 5% hospitals). Fewer than half of hospitals had all resources needed to provide oxygen. One hundred and forty-five of 956 cases evaluated underwent operations under general or spinal anaesthesia. We found operation notes for 99% and anaesthetic records for 72%. Pre-operatively measured vital signs were recorded in 80% of cases, and evidence of consent to operation was found in 78%. Blood loss was documented in only one case and sponge and instrument counts in 7%.
  
  
  CONCLUSIONS
  Evaluation of surgical services would be improved by development and dissemination of clear standards of care. This survey suggests that internship hospitals may be poorly equipped and documented care suggests inadequacies in quality and training.
authors.affiliation: KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Ministry of Health, Government of Kenya, Nairobi, Kenya.
authors.forename: Stephen
authors.initials: S
authors.lastname: Mwinga
authors.forename: Colette
authors.initials: C
authors.lastname: Kulohoma
authors.forename: Paul
authors.initials: P
authors.lastname: Mwaniki
authors.forename: Rachel
authors.initials: R
authors.lastname: Idowu
authors.forename: John
authors.initials: J
authors.lastname: Masasabi
authors.forename: Mike
authors.initials: M
authors.lastname: English
mesh_terms: D003430:Cross-Sectional Studies; D013502:General Surgery / Q000592:standards*; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007630:Kenya; D011787:Quality of Health Care; D013514:Surgical Procedures, Operative / Q000592:standards*
keywords: Calidad de cuidados; chirurgie; cirugía; hospital; hôpital; quality of care; qualité des soins; surgery; trauma; traumatisme