title: Engaging staff to improve quality and safety in an austere medical environment: a case-control study in two Sierra Leonean hospitals.
abstract: OBJECTIVE
  Inadequate observance of basic processes in patient care such as patient monitoring and documentation practices are potential impediments to the timely diagnoses and management of patients. These gaps exist in low resource settings such as Sierra Leone and can be attributed to a myriad of factors such as workforce and technology deficiencies.
  
  
  METHODS
  In the study site, only 12.4% of four critical vital signs were documented in the pre-intervention period.
  
  
  METHODS
  Implement a failure mode and effects analysis (FMEA) to improve documentation of four patient vital signs: temperature, blood pressure, pulse rate and respiratory rate.
  
  
  METHODS
  FMEA was implemented among a subpopulation of health workers who are involved in monitoring and documenting patient vital signs. Pre- and post-FMEA monitoring and documentation practice were compared with a control site.
  
  
  RESULTS
  Participants identified a four-step process to monitoring and documenting vital signs, three categories of failure modes and four potential solutions. Based on 2100 patient days of documentation compliance data from 147 patients between July and November 2012, staff members at the study site were 1.79 times more likely to document all four patient vital signs in the post-implementation period (95% CI [1.35, 2.38]).
  
  
  CONCLUSIONS
  FMEA is a feasible and effective strategy for improving quality and safety in an austere medical environment. Documentation compliance improved at the intervention facility. To evaluate the scalability and sustainability of this approach, programs targeting the development of these types of process improvement skills in local staff should be evaluated.
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Rosen, MD, USA Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Department of Health, Policy, and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA Johns Hopkins University School of Nursing, Baltimore, MD, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rosen
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Adaora M
authors.initials: AM
authors.lastname: Chima
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: John B
authors.initials: JB
authors.lastname: Sampson
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Value Institute, Christiana Care Health System, Wilmington, DE, USA.
authors.forename: Eric V
authors.initials: EV
authors.lastname: Jackson
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Koka
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Megan K
authors.initials: MK
authors.lastname: Marx
authors.affiliation: Department of Surgery, Connaught Hospital, Freetown, Sierra Leone.
authors.forename: Thaim B
authors.initials: TB
authors.lastname: Kamara
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Onyebuchi U
authors.initials: OU
authors.lastname: Ogbuagu
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Lee
mesh_terms: D016022:Case-Control Studies; D003906:Developing Countries; D004282:Documentation / Q000379:methods / Q000592:standards; D006801:Humans; D009741:Nursing Staff, Hospital / Q000193:education / Q000592:standards; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration; D012807:Sierra Leone; D062606:Tertiary Care Centers / Q000592:standards; D055986:Vital Signs
keywords: appropriate health care; developing countries; experimental research; general methodology; health-care system; hospital care; human factors; organization science; patient safety; practice variations; qualitative methods; quality improvement; quality management; setting of care; specific populations