ISQUA16-1718IMPROVING SEVEN-DAY POST-OPERATIVE FOLLOW-UP RATE AT IGANGA ISLAMIC MEDICAL CENTER IN UGANDA

Abstract

Objectives: 1. To improve the proportion of circumcised clients who return for the seven-day post-operative follow-up visits using a systematic quality improvement approach. Method(s): Among the key objectives of USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project in Uganda is to support other implementing partners. One such partner is USAID Uganda Private Health Support Program (USAID UPHS) which directly supports Iganga Islamic Medical Center to deliver quality and safe HIV prevention, care and treatment services. This has been done using the quality improvement approach to ensure and support safety for the clients receiving voluntary medical male circumcision (VMMC) for HIV prevention. The improvement work began by supporting USAID UPHS to collect baseline data on particular quality improvement indicators like seven-day post-operative follow-up rate that showed a median performance of 0% across the baseline period of January to June 2014, which is way below the required standard of 100%. The health facility was supported to form an improvement team which received training in quality improvement systems, processes and approaches followed by monthly site coaching visits. During the problem analysis discussion with the health care workers it was identified that appointments were just being written on the client cards as required but with no explanation to the clients about the benefits or importance of the seven-day postoperative follow-up. The health care workers were then oriented on the importance of the seven-day post-operative follow-up visits; they decided to also emphasize and discuss this with the clients during the group pre-operative client education in addition to giving the required appointment dates. Systems were also set up to ensure that clients circumcised during outreaches were also reviewed by the health care workers going back to the outreach site on the seven-day appointment date. These activities were made part of the routine activities and a schedule drawn for responsible persons to do the pre-operative group education for the clients to be circumcised. Result(s): The proportion of circumcised clients that returned for the seven-day post-operative follow-up visit progressively improved to 75% by February 2015 and to 91% by April 2015 having incorporated going to the outreach sites on the follow-up appointment dates. This good performance has been sustained beyond October 2015 when the site was phased from the intense support to a light support site. Post-operative follow-up visits have been maintained above 95%. Conclusion(s): Following a systematic approach to addressing gaps and involving the key players in the improvement process to select particular interventions increases the chances that they will be adopted and hence their success. Health care workers have to clearly understand the benefits of post-operative follow-up for them to clearly explain to the clients these benefits.