Sri Lanka is a country known to the world for providing cost effective healthcare free of direct cost to the patient. The maternal mortality ratio, neonatal mortality rate, life expectancy at birth and many more health indices are comparable with those of the developed world. Although these Sri Lanka is renowned for best indicators in the region, much has to be done to ensure quality and safety in the delivery of healthcare, especially in hospitals.
Directorate of Healthcare Quality and Safety has prepared the Clinical Indicators for all four major specialties namely Medicine, Surgery, Paediatrics and Obstetrics & Gynaecology in collaboration with the relevant colleges. Several consultative meetings were held with the participation of members from each to prepare the indicators.
There are five clinical indicators regarding each major specialty, which are used to monitor the quality of care of at the quarterly performance review meetings at the DHQS.
Clinical indicators of Medicine.
- Percentage of patients given a fibrinolytic in <30 minutes of arrival in ST Elevation
- Myocardial Infarction (STEMI) or undergoing primary Percutaneous Coronary
- Intervention (Percutaneous Coronary Intervention) in <90 minutes of arrival to hospital.
- Percentage of patients with diabetes who are attending to Medical clinics, having FBS measured at least once in two months or HbA1C measured at least once in 6 months and controlled to target FBS < 126mg/dl and HbA1C < 7.
- Percentage of patients with BP controlled to target < 140/90mmHg in the patients with cardiovascular risks.
- Percentage of errors in administration of prescribed medication to the right patient at any stage of medication process (i.e., prescribing, transcribing, dispensing, administration and monitoring)
- Percentage of patients with a physician diagnosis of asthma who receive outpatient/ETU/PCU nebulisations.
Clinical Indicators of Surgery
- Rate of Postponement of Elective Surgery.
- Waiting time duration in indexed operations. Divided into cancer and non-cancer.
- Percentage of Surgical facilities using the ‘Surgical Safety Checklist.
- Rate of Surgical Site Sepsis.
- Average hospital stay after an index operation (ex: Appendicitis, inguinal hernia, amputation for diabetic gangrene)
Clinical Indicators of Paediatrics
- Hypothermia on admission to Neonatal Unit when transferring from one institution to another (outside born baby) or from the maternity unit to the neonatal unit in the same hospital (in born baby).
- Re-admission to the ward with wheezing who had bronchiolitis under oneyear of age.
- Readmission rate within 14 days following discharge from a Paediatric ward.
- Hypoglycemia on Admission to the Neonatal Unit when transferring from one institution to another (Outside born baby) or from the maternity unit to the neonatal unit in the same hospital (In born baby).
- Case fatality rate in Dengue Hemorrhagic Fever.
Clinical Indicators of Obstetrics & Gynaecology
- Labour Induction Rate.
- Episiotomy rate.
- Caesarian section rate.
- Proper use of Partogram
- Average waiting time for routine major Gynaecological surgery
DHQS is currently in the process of revising the Clinical Indicators in four major specialties Initial consultative meetings were held in Surgery, Pediatrics and Obstetrics and Gynecology.
