Advancing obstetric and neonatal care in a regional hospital in Ghana via continuous quality improvement

Objective: To reduce maternal and neonatal death at a large regional hospital through the use of quality improvement methodologies. Methods: In 2007, Kybele and the Ghana Health Service formed a partnership to analyze systems and patient care processes at a regional hospital in Accra, Ghana. A model encompassing continuous assessment, implementation, advocacy, outputs, and outcomes was designed. Key areas for improvement were grouped into "bundles" based on personnel, systems management, and service quality. Primary outcomes included maternal and perinatal mortality, and case fatality rates for hemorrhage and hypertensive disorders. Implementation and outcomes were evaluated tri-annually between 2007 and 2009. Results: During the study period, there was a 34% decrease in maternal mortality despite a 36% increase in patient admission. Case fatality rates for pre-eclampsia and hemorrhage decreased from 3.1% to 1.1% (P < 0.05) and from 14.8% to 1.9% (P < 0.001), respectively. Stillbirths were reduced by 36% (P < 0.05). Overall, the maternal mortality ratio decreased from 496 per 100 000 live births in 2007 to 328 per 100 000 in 2009. Conclusion: Maternal and newborn mortality were reduced in a low-resource setting when appropriate models for continuous quality improvement were developed and employed. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.