Types and prevalence of adverse events among obstetric clients hospitalized in a secondary healthcare facility in Ghana

Objective The main objective of this study was to determine the types and prevalence of adverse events among obstetric clients hospitalized in a secondary health facility in Ghana. Design A retrospective study that reviewed medical records of obstetric clients on admission at the Obstetrics Unit of a secondary healthcare facility in Ghana. Setting Clinical environment. The study site is the third largest health facility in Ghana that provides maternity services and serves as the major referral facility for Greater Accra Region, the capital of Ghana. About 41% (4676) of its total antenatal cases (11,406) in 2015 were referrals from other facilities in Ghana. The medical records were reviewed retrospectively from 1 January to 31 December 2015. A four-stage review process was used: the first and second stages (by nurse/midwife reviewers) involved the identification and exclusion of records that had a length of stay less than 24 h and inadequate documentation; and were unlikely to include an adverse event. The third stage by obstetrician gynaecologist reviewers included a full review of all the positive trigger folders to determine the types, causes and degree of preventability of the adverse events. The fourth stage involved an independent obstetrician gynaecologist review of all records that had discrepancies. Details of the review process are presented in the figure. Participants Obstetric clients (i.e. pregnant women at any stage of gestation or less than 5 days after delivery who were attended to at the hospital). About a third (1402, 49.3%) met the inclusion criteria and were reviewed. Main outcome measures The main outcome measure for this study was the prevalence of adverse events among hospitalized obstetric clients. Results The prevalence of adverse events was 12% (168) out of 1402 records reviewed. The mean maternal age of the clients was 30.0 ± 5.8 years. Among these, the greatest proportion of adverse events was related to surgical interventions (66.3%) and the smallest were related to patient care (0.7%). Conclusions This study has provided the first documented prevalence (12.0%) and types of adverse events among hospitalized obstetric clients in a secondary health facility in Ghana. It provides a preliminary baseline for the burden of adverse events among the obstetric population in Ghana.