Quality and Safety of More Complex Argentine Public Maternity Hospitals. Results of External Evaluations

Abstract

INTRODUCTION: To contribute to reducing maternal and infant mortality, the National Ministry of Health implemented a project of external evaluation (EE) of public hospitals providing maternity care under category IIIB. OBJECTIVE: To evaluate the quality and safety in maternity hospitals in Argentina. METHODS: The study used a tool with 254 risk-weighted standards, including 24 trained evaluators, tracing of patient care, interviews with staff and patients, document review, visits to services, photos, and observation. Information was gathered from primary sources. RESULTS: A total of 16 hospitals were evaluated (median: 4125 births annually). The processes of highest-risk were: medication management, surgery, error reporting, patient identification, adult cardiopulmonary resuscitation and obstetric emergency preparedness, communication, staff and services (continuity of care, personnel on-duty, availability of ultrasound examinations, anesthesiologists, auxiliary personnel, control of competencies, use of guidelines), infection control, and safety of the environment. CONCLUSIONS: Many unsafe processes were identified in highcomplexity public maternity hospitals. EEs are effective for gathering information about risks, prioritizing processes for improvement, and estimating the frequency of occurrence of systemic problems. They should be part of a national quality strategy considering support, incentives, and mandatory requirements so that hospitals take action to reduce risk.