Nigerian Hospital Practice

Improving Efficiency Of Patients Discharge Process In A Private Multi-Speciality Hospital

2025-02-03T20:51:06+00:00

Summary:

For a long time now hospital believed that one way to improve efficiency is by employing more human and non-human resources to processes. Unknown to many however there may be inherent process ﬂow problems that need to be addressed rather than just improving the resources available. This research was conducted at Cedarcrest Hospitals Abuja which is a 60 bedded private multi-speciality hospital with over 2000 inpatient admissions yearly. Our target for the project was to optimize efficiency and enhance patient ﬂow by improving patient discharge process and reducing the length of stay (LOS) in the hospital. Nine intervention measures were developed and tested. There was a significant reduction in the average discharge time recorded from 469.80 minutes (7.83 hours) during the first 6 months of the pre-intervention phase to 262.80 minutes (4.38 hours) across the entire post-intervention phase indicating a 44.08% reduction (p < 0.001, t-test) following the introduction of the 9 key intervention measures. It is therefore very vital for all stakeholders, both internal and external to the hospitals to play their roles effectively in order to improve the overall hospital efficiency.

The Comparison of Retrobulbar Block with Topical-Anterior Subconjunctival Anaesthesia for Small Incision Cataract Surgery: A Randomized Control Trial

2025-02-03T21:01:36+00:00

Summary:

Sight and life-threatening complications following retrobulbar block resulted in the emergence of alternative local anaesthetic techniques such as sub-Tenon block, peribulbar, intracameral, sub-conjunctiva and topical anaesthesia. This study compared the visual analogue pain score, comfort score and patients' satisfaction between retrobulbar block and topical- Anterior subconjunctival anaesthesia in patients scheduled for small incision cataract surgery (SICS). This was a single-blinded clinical trial conducted in 62 ASA I-II patients, aged 50 to 90 years scheduled for small SICS, 31 patients were randomly assigned to receive either Retrobulbar Block (RB), or Topical-Anterior Subconjunctival Anaesthesia (TASCA). In the RB group, a mixture of 2% lidocaine, and 3.75IU/mls of hyaluronidase (Wydase), to make up a total volume 4.0 mls was injected into the retrobulbar space. Topical-Anterior Subconjunctival anaesthesia (TASCA) group involved the administration of an initial drop of 2% topical lidocaine prior to the application of the speculum followed by anterior subconjunctival injection of 0.2 ml of 2% lidocaine and maximum total dose of 3 drops (appropriately 40 µL per dose) of 2% topical lidocaine at intervals depending on participant's pain and comfort. We evaluated visual analogue pain scale (VAPS), comfort score and patients' satisfaction during SICS for both groups. A significantly higher number of patients in the TASCA group reported higher intraoperative pain with VAPS ≥5, p <0.001. Chemosis was significantly higher in the RB group, 43.8%, than in the TASCA group 10%, p =0.003. However, the postoperative VAPS, comfort score, and patients' satisfaction were comparable, p>0.05 in both groups. Topical-Anterior subconjunctival anaesthesia was associated with intraoperative pain and lower complication rates compared to retrobulbar block. However, postoperative pain, comfort score and patients' satisfaction were comparable in both groups.

Major limb Amputations in a Tertiary Hospital in South Western, Nigeria: Are There Changes in Demographic and Reasons for Amputation Yet?

2025-02-03T21:10:22+00:00

Summary:

Major limb amputations remain one of the common procedures performed in the hospitals to preserve life and/or relief pain. This procedure can lead to major life style changes and is better prevented, whenever possible. Limb complications from Diabetes mellitus and trauma, from road traﬃc accident, were two major reasons for amputation. There has been a change in the transport policy in Lagos state with a ban on the use of commercial motorcycles plying major roads within the state for some years now. This study was conducted to document any change in the demographics and reasons for amputation after the implementation of the policy. The present results were compared with previously published results from same and other centres within Lagos and around Nigeria. This was a retrospective study that spanned 4(four) years. Medical and theatre records of patients who had major limb amputation within the period were reviewed and data collected. Data analysis was done and results presented. The average age of the one hundred and twenty patients who had major limb amputations was 53.5 ± 18.0 years. The age group 50 – 59 years were mostly aﬀected (33.6%). Male to female ration was 1:1. The commonest reason for amputation was gangrene from diabetic mellitus foot syndrome (59.2%) followed by trauma (11.7%) and peripheral arterial disease (9.2%). Diabetic mellitus foot syndrome remained the major reason for major limb amputation but the frequency of trauma as a reason for amputation has reduced when compared with previously published results.

Vaginal Laceration with Prolapse of Intestine following Sexual Intercourse: A Case Report

2025-02-03T21:14:33+00:00

Summary:

This is a case presentation of a 16-year-old female who presented to the emergency department with sudden onset of severe vaginal bleeding and lower abdominal pain following consensual but aggressive sexual intercourse with a male partner. There was an initial history of her receiving care from an unskilled attendant. Subsequently, she was admitted in our hospital following a sudden onset of bleeding per vagina and a small bowel prolapse per vagina. On examination, she was hemodynamically stable, pelvic examination revealed a 6 cm posterior laceration of the vagina with loops of small intestine visible at the introitus. The patient was immediately stabilized with intravenous ﬂuids and blood transfusion and subsequently had emergency exploratory laparotomy. She tolerated the procedure well, and there were no intraoperative complications. This case report illustrates the potential for serious coital injuries resulting from aggressive sexual practices. Prompt recognition, prompt and appropriate steps by a patient and surgical intervention are critical to preventing worsening outcomes.