Real-world implementation challenges in low-resource settings

Kathryn M Chu,Thomas G Weiser

doi:10.1016/s2214-109x(21)00310-7

Abstract

Real-world implementation challenges in low-resource settings

Highlights

Postoperative mortality is disproportionately high in low-income and middle-income countries (LMICs)
As reported in The Lancet Global Health, African Surgical Outcomes Study (ASOS)-2, a cluster-randomised controlled trial, developed this earlier work to assess an intervention aimed at reducing postoperative mortality.[2]
A package of five interventions were applied to patients at high risk on the basis of the clinical concept of failure to rescue—ie, that postoperative complications require active intervention and that hospitals with high rates of mortality fail to rescue deteriorating patients.[3]. This package included admitting the patient to a higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to say in the ward, and placing a postoperative surveillance guide in a visible position at the bedside

Summary

Introduction

Postoperative mortality is disproportionately high in low-income and middle-income countries (LMICs). In 2019, the African Surgical Outcomes Study (ASOS) collaborative prospectively followed 11 422 patients in 25 African countries and showed that postoperative morality in this setting is twice as high as the global average.[1] As reported in The Lancet Global Health, ASOS-2, a cluster-randomised controlled trial, developed this earlier work to assess an intervention aimed at reducing postoperative mortality.[2] A package of five interventions were applied to patients at high risk on the basis of the clinical concept of failure to rescue—ie, that postoperative complications require active intervention and that hospitals with high rates of mortality fail to rescue deteriorating patients.[3] This package included admitting the patient to a higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to say in the ward, and placing a postoperative surveillance guide in a visible position at the bedside.

Results

Conclusion