Improving quality in resource poor settings: observational study from rural Rwanda

doi:10.1136/bmj.b3488

Published 30 October 2009, doi:10.1136/bmj.b3488
Cite this as: BMJ 2009;339:b3488

Practice

Quality Improvement Report

Improving quality in resource poor settings: observational study from rural Rwanda

Meera Kotagal, volunteer, student¹^,2, Patrick Lee, clinical mentor, hospitalist physician, clinical instructor in medicine¹^,2^,3, Caste Habiyakare, nurse⁴, Raymond Dusabe, doctor⁴, Philibert Kanama, nursing director⁴, Henry M Epino, medical director, attending physician, instructor in surgery¹^,2^,5, Michael L Rich, director⁶, Paul E Farmer, co-founder, Presley professor, chief¹^,7^,8

¹ Partners In Health, 888 Commonwealth Avenue, Third Floor, Boston, MA 02215, USA, ² Harvard Medical School, 260 Longwood Avenue, Boston, MA 02115, ³ Newton-Welleseley Hospital, 2014 Washington Street, Newtown, MA 02462, ⁴ Kirehe District Hospital, Rwanda Ministry of Health/Partners In Health, Kigali, Rwanda, ⁵ Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, ⁶ Partners In Health, PO Box 3432, Kigali, Rwanda, ⁷ Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston MA 02115, ⁸ Division of Global Health Equity, Brigham and Women’s Hospital 651 Huntington Avenue 7th Floor, Boston, MA 02115

Correspondence to: M Kotagal, Department of Surgery, University of Washington, Box 356410, Seattle, WA 98195, USA mkotagal@post.harvard.edu

The first 150 words of the full text of this article appear below.

Problem Hospitals in rural Africa, such as in Rwanda, oftenlackelectricity, supplies, and staff. In our setting, basiccareprocesses, such monitoring vital signs, giving drugs, andlaboratorytesting, were performed unreliably, resulting indelays in treatmentowing to lack of information needed forclinical decision making.

DesignSimple quality improvement tools, including plan-do-study-actcyclesand process maps, were used to improve system level processesina stepwise fashion; resources were augmented where necessary.

Setting50 bed district hospital in rural Rwanda.

Measurement of improvementThree key indicators (percentageof vital signs taken by 9 am,drugs given as prescribed, andlaboratory tests performed anddocumented) were tracked daily.Data were collected from a randomsample of 25 charts from sixinpatient wards.

Strategy forchange Our intervention had two components: staffeducationon quality improvement and routine care processes,and stepwiseimplementation of system level interventions. Realtime . . . [Full text of this article]

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