Abstract
BackgroundQuality of patient care in hospitals has been shown to be inconsistent during weekends and night-time hours, and is often associated with reduced patient monitoring, poor antibiotic prescription practices and poor patient outcomes. Poorer care and outcomes are commonly attributed to decreased levels of staffing, supervision and expertise and poorer access to diagnostics. However, there are few studies examining this issue in low resource settings where mortality from common childhood illnesses is high and health care systems are weak.MethodsThis study uses data from a retrospective cross-sectional study aimed at “evaluating the uptake of best practice clinical guidelines in a tertiary hospital” with a pre and post intervention approach that spanned the period 2005 to 2009. We evaluated a primary hypothesis that mortality for children with pneumonia and/or dehydration aged 2–59 months admitted on weekends differed from those admitted on weekdays. A secondary hypothesis that poor quality of care could be a mechanism for higher mortality was also explored. Logistic regression was used to examine the association between mortality and the independent predictors of mortality.ResultsOur analysis indicates that there is no difference in mortality on weekends compared to weekdays even after adjusting for the significant predictors of mortality (OR = 1.15; 95% CI 0.90 -1.45; p = 0.27). There were similarly no significant differences between weekends and weekdays for the quality of care indicators, however, there was an overall improvement in mortality and quality of care through the period of study.ConclusionMortality and the quality of care does not differ by the day of admission in a Kenyan tertiary hospital, however mortality remains high suggesting that continued efforts to improve care are warranted.
Highlights
Quality of patient care in hospitals has been shown to be inconsistent during weekends and nighttime hours, and is often associated with reduced patient monitoring, poor antibiotic prescription practices and poor patient outcomes
Quality of care over weekends Quality of patient care in hospitals has been shown to deteriorate at weekends and at night [1,2] with reduced patient monitoring, poor antibiotic prescription practices and poor patient outcomes [3,4,5]
We set out to examine whether children admitted at weekends were at higher risk of death than those admitted at other times in a large Kenyan tertiary hospital, Kenyatta National Hospital (KNH)
Summary
Quality of patient care in hospitals has been shown to be inconsistent during weekends and nighttime hours, and is often associated with reduced patient monitoring, poor antibiotic prescription practices and poor patient outcomes. In Kenyatta National Hospital pneumonia and dehydration contribute to 55% of the admissions and 45% of the deaths [8] in the under fives. Care for these children is defined by explicit national guidelines [9] that provide standards for assessing quality of care. We examined a secondary hypothesis, whether being admitted at the weekend with pneumonia or dehydration is associated with poorer quality of admission care, as a possible mechanism for higher mortality
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