Achievements In Managing Patient Care In The Medical Dept of Kamuzu Central Hospital

The challenges

As one of the two major tertiary level referral centres in Malawi, Kamuzu Central Hospital faces major problems in coping with its immense work- and patient-load.  In mid-2007, there were 49 beds in the Medical Ward, but up to 120 patients were being admitted. The overcrowding was increasing the risk of nosocomial infections and early death and staff with such heavy workloads were demotivated.

Objectives and approach

A problem analysis revealed that ward rounds were erratic; supervision was poor; there were no standardized approaches to diagnosis and treatment; there was no continuous medical education; close links were not made with other stakeholders, such as the Lighthouse and the districts.

Results

The following decisions were taken and systematically introduced on the ward:

1. Triage on admission to the ward.
2. All patients are to be seen by a consultant within 24 hrs of arrival on the ward.
3. Diagnostics have been rationalised and accelerated by various measures
4. Treatment protocols have been adapted, using principles of evidence-based medicine.
5. Once a week the specialists conduct a teaching round.
6. Twice a week in-service training sessions are held (case presentations, ‘Journal Club’).
7. Once a month a meeting is held to review morbidity and mortality.

These improvements resulted in a marked reduction in workload and therefore in hospital running costs.  Most importantly, there has been a reduction in mortality. For the Male Medical Ward, a comparison between Jan-Oct 2007 and Jan-Oct 2008 shows a 27% reduction in mortality, or 200 lives saved.  Even more striking is the reduction in deaths among patients who stay on the ward longer than 48hrs – the reduction in mortality is 52.7%.