J. E. Dos Santos Souza1, S. Saluja2,4, J. Amundson2,3, R. V. Ferreira1, I. Citron2, P. H. Gomes1, J. Correia1, C. Costa1, N. Alonso5,6, M. Shrime2,7 1Universidade Estadual Do Amazonas,Faculdade De Medicina,Manaus, AMAZONAS, Brazil 2Harvard School Of Medicine,Program In Global Surgery And Social Change,Boston, MA, USA 3University Of Miami,Miller School Of Medicine,Miami, FL, USA 4Weill Cornell Medical College,Department Of Surgery,New York, NY, USA 5Universidade De Sáo Paulo,Craniofacial Surgery Unit, Division Of Plastic Surgery, Department Of Surgery,Sáo Paulo, SÁO PAULO, Brazil 7Massachusetts Eye And Ear Infirmary,Department Of Otology And Laryngology And Office Of Global Surgery,Boston, MA, USA
Introduction: Five billion people lack access to safe and affordable surgical, anesthetic and obstetric care when needed. In 2015, the Lancet Commission on Global Surgery – an academic global consortium – summarized the state of surgical care internationally. The Commission proposed six indicators for evaluating surgical systems. To assess the health of a national surgical system, a mixed-methods qualitative and quantitative Hospital Assessment Tool (HAT) has been developed. The tool will be used in Brazil’s largest and most rural state, Amazonas, to identify priority areas for system improvement and health policy changes, as perceived by local patients and providers. The deployment of the tool involves a partnership between Harvard Medical School and local collaborators at Universidade do Estado de Amazonas (UEA). The aim is to apply this validated tool to a broad range of settings worldwide.
Methods: An initial pilot of the HAT was undertaken in Cabo Verde, Ethiopia, and India. The tool was then adjusted and validated by 18 experts (Delphi consensus). Over six months, the HAT will be deployed by researchers from UEA at hospitals in 20 municipalities across the state. To select which municipalities to assess, municipalities performing surgery were stratified by population quartile and selected at random within each stratum. At each site, the UEA team will gather quantitative survey data and qualitative interviews. Interview transcriptions will subsequently be evaluated using framework analysis. A selection of sites will undergo repeat data collection at 6-week intervals by a separate team to assess inter-rater and inter-temporal validity.
Results: To date the investigators have visited 6 of 20 target hospitals, with data collection projected to finish by late 2016. Inhalation general anesthesia is available at 1/6 hospitals; IV sedation, spinal and regional anesthesia is available at 3/6 hospitals. Blood bank services are available at 5/6 hospitals, with average time to access less than 30 minutes at 4/5 hospitals. No hospital reported use of the WHO safe surgery checklist. 2/6 hospitals performed procedures other than cesarean section in past 6 months, and 1/6 in the past 30 days. Only 1/6 hospitals reported continuous vital sign monitoring in the PACU. 2/6 hospitals have internet.
Conclusion: This project provides the framework for a successful partnership engaging local stakeholders in meaningful research to influence their own regional surgical agenda. Preliminary quantitative results show a significant lack of basic tools to perform safe surgery across the municipalities of Amazonas.
