Critical incidents in gynaecology: a one year audit in an academic hospital in Johannesburg, South Africa

Abstract

Introduction: critical incidents are among the ten leading causes of death and disability worldwide. Improving patient safety is a global priority and one way of achieving this goal is to report and analyse critical incidents. We aimed to establish the incidence, describe the profile, patient outcomes and avoidable factors associated with gynaecological critical incidents in an academic hospital in Johannesburg, South Africa.

Methods: this is a retrospective descriptive analysis of critical incidents in patients admitted to gynaecology wards at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) from 1^st January 2019 to 31^st December 2019. All medical records of patients identified to have experienced critical incidents were reviewed and demographic information, timing of admission, critical incidence markers and avoidable factors were extracted and analysed.

Results: there was a total of 176 critical incident events and 2082 gynaecology admissions during the 1-year study period. Only 158 critical incident files were available and complete to enable analysis. This gave a critical incidence rate of 7.6% (158/2082). The mean age (SD) of the patients was 41.1 (14.8) years and the median (IQR) duration of admission was 6 (3-10) days. The main causes of critical incidents were omission of procedures (n=45, 17.5%), deaths (n=34, 13.2%), massive transfusion (n=30, 11.7%), repeat laparotomies (n=29, 11.3%) and fistula/organ damage (n=19, 7.4%). There were 111 (70.3%) avoidable factors in the 158 critical incident cases. Most of the avoidable factors were medical care related, 53 (47.8%), followed by administrative factors, 33 (29.7%) with patient-related factors in the least at, 25 (22.5%). Critical incident forms were only filled out in 39 out of the 176 (22.2%) patients identified to have suffered a critical incident.

Conclusion: the critical incidents rate in this institution is within the range reported in the literature however underreporting is a major concern. The leading causes of critical incidents were omission of procedure, followed by deaths. Approximately two-fifths of the critical incidents were associated with some form of harm, ranging from mild disability to deaths. Most of the avoidable factors were health system-related (medical care and administrative). The department should focus on improving critical incident reporting systems and the quality of care to reduce the number of critical incidents.