Title

Assessing the quality of care for victims of motorcycle injuries: a case study in the tertiary care private and public hospitals of Karachi

Date of Award

2012

Document Type

Thesis

Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)

Department

Community Health Sciences

Abstract

Background Road Traffic Injury (RTI) is a huge public health issue globally, being the ninth leading cause of death worldwide and by 2030 it is expected to become the 5th leading cause of death. There is a need to train the health professionals for better outcomes of trauma care especially in the poor health settings where low levels for job satisfaction further compromises the quality of healthcare services. A positive relationship exists between the satisfaction of employees and the quality of the patient experience in hospitals; with good employee satisfaction and skills leading to better patient satisfaction. This paper aims to holistically assess quality of care provided to victims of motor cycle injuries in three hospitals of Karachi Pakistan in terms of clinical management, patient and employee satisfaction and identify areas for improvement. Methodology The study in three tertiary care hospitals of Karachi used a case study methodology with a mixed methods approach for data collection. Aspects of paradigm model were used to better understand the quality of care in the three hospitals. Desk reviews of 90 medical records in the three study hospitals helped to identify clinical management of victims in terms of standard criteria set by ACSCOT. A cross-sectional survey (Hospital A, n= 150) and an observation based diary (Hospital B, C) helped to understand context of staff and patient satisfaction with quality of services provided. Results Based on standard parameters for timely clinical care, ACSCOT filters were categorized as prompt, appropriate and delayed. Time to intubation was appropriate in Hospital A and B (60%) and delayed in Hospital C (50%). Time to assessment by neurosurgical team was prompt in Hospital A (37%), appropriate in Hospital B (77%), and delayed in Hospital C (53%). Time to consultation for associated injury was appropriate in Hospital A (43%), delayed in Hospital B (60%) and appropriate in Hospital C (77%). Time to CT scan was prompt in all the three hospitals while time to surgery was prompt in Hospital A (47%) and delayed in Hospital B and C. Time in ER was less than 72 hours in all the three hospitals. Serial GCS recording was appropriate in Hospital A, inappropriate in Hospital B and absent in Hospital C. Patient satisfaction was 74% and employee satisfaction was 89% in Hospital A. In Hospital B patient satisfaction was observed to be quite good whereas in Hospital C it was suboptimal. The employees of hospital A had 88% of staff appropriately trained in trauma care; employees in hospital B had relatively better skills and job satisfaction than Hospital C. Prompt clinical management in ER had significant positive correlation with optimistic perceptions about the quality of care by the patients in Hospital A. Time to intubation (r =1, p =.000), attendance by neurosurgical team (r =.855, p =.003), consultation for associated injury (r =.835, p =.000), and time to CT scan (r =.787, p =.000), and surgery (r =.767, p =.000) were significantly positively correlated with patient satisfaction. Conclusion Method triangulation provided common and contrasting results between the three hospitals. Quality of care should be viewed as a continuum with a balanced weightage assigned to clinical care, staff and patient satisfaction. The positive attributes in Hospital A (a not for profit teaching private hospital) i.e. prompt and appropriate clinical management (evidenced by ACSCOT markers), better infrastructure, implementation of standard procedures and protocols and trained staff translated into better patient satisfaction with quality of care. Both hospital B and C are public sector hospitals and have staff with similar skills and competencies and a greater patient load than Hospital A. Despite these similarities hospital B was relatively better off than hospital C in terms of overall quality of care as evidenced by its clinical management and observed patient satisfaction. Since hospital C lacked most of the positive attributes, relatively speaking it lagged behind. Policy Recommendations Implementation challenges for efficient quality of care for victims of motorcycle injuries includes prompt clinical management in accordance with standard ACSCOT guidelines and appropriate staffing ratios with certified training in trauma care, structural improvements in the infrastructure, better managerial coordination and adherence to policies and procedures which can result in good quality care and enhanced patient satisfaction even in public sector hospitals. Originality/value The paper bridges an important gap in the literature by holistically assessing quality of care provided to trauma victims in terms of clinical management and employee and patient satisfaction. As such a new and balanced systems perspective is added to improve efficiency of trauma care.

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