WPHA Surgical Audits for 2021

Consultant : EJ Yakea
Period: January 2021 to January 2022
Kiunga District Hospital
Outline
KRA 1: Effective engagement
• Surgical outreach to rural setting

KRA 2: Partnership
• Surgeons' visits from outside

KRA 3: Improve quality

• Clinical audits
• M&M
KRA 4: Address Disease Burdens and targeted priorities
• Cancer
• Trauma
• Women's health
• Men's health

KRA 5: Strengthen health systems and governance

• CME
• Procurement
• Accountability
Geography
• Hospital capacity: 49 beds, Level 4 facility
• Surgical ward: 8 beds
• Bed occupancy rate: 10.8%
• Bed turn around rate: 31%
• Bed to population ratio: 0.77
• ALHS: 11 days
KRA 1: Healthier communities through effective
engagement

Surgical outreach: 3
• Total pt seen: 89
• Total minor cases: 15

Communities sustaining Training communities about Refueling

own health Home visitations: 11
preventative measures

Surgical outreach Repatriation Surgical retrieval Upskilling

 KRA 2: Partnership
• Locum Surgeons in
2021
• Dr P. Opum
• Dr K. James • Total pts seen at SOPC: 294
• Total admitted: 61
• Dr Japhlet • Total Operations: 69
• Dr A. Danlop • Outcome:
• X 1 wound break down
• Dr F. Maeno
• Dr Tamilong (O&G)
KRA 3: Improve access to quality
and affordable health services

• Staff filing
• Essential Manpower
• New Structure
• Assets
• Clinical pathway
• Standard operational procedures
• Referral pathway
• Mortality reviews
• Surgical audits
• Rehabilitation programs
 61 in
336
Operations
3 out
Referrals

1679 11
Clinic visits Deaths

318
Admissions
Summary
INDICATORS TOTAL Trauma Cases 142
Month Admission Discharge Clinics Operations Referrals Transfer out Deaths Total Consultation 1679
in - New Consults 1047 Total Deaths in unit 11
Jan 27 22 110 32 9 0 1
- Review 632
Feb 23 19 143 30 7 0 1 318 Mortality Rate 3%
Total Admissions
March 28 20 130 32 0 0 1
General Admissions 136
April 29 28 131 45 0 0 0 Post-operative Death 4
Specialty Admissions 200
May 32 29 203 39 8 1 2
June 30 28 147 24 5 0 0 Total Discharges 249 1%
POMR (%)
July 41 36 177 35 12 1 3 Booked surgical cases 350
Aug 17 17 121 20 7 0 0 Surgical operations 336 Consultation – in 14
Sept 16 11 128 17 4 0 1 -Emergencies 132
Oct 30 14 149 22 3 0 1 -Electives 204 Consultation – out 11
Nov 28 12 177 23 3 1 1 - Major 67
Dec 17 13 63 17 3 1 0 Transfers – in 61
- Intermediate 77
Total 318 249 1679 336 61 3 11
- Minor 192 3
Transfers – out
OT Take-back 10
Day surgeries 48 Referrals in from PHA’s 0
OT cancellations 14
-Emergencies 0 ~ Length of hospital 11 DAYS
-Electives 14 stay (days)
Post-Op Complications 2 Bed occupancy rate (%) 10.8%
Age/Sex Distribution
Age (years) Number of patients (%) Sex
Male Female
0 to 9 15 4.00% 9 2 Female > males
10 to 19 62 18.00% 16 18
20 to 29 73 22.00% 23 31
30 to 39 89 26% 29 52
40 to 49 56 17% 33 43 30 – 39 years: 26%
50 to 59 24 7% 27 23
60 to 69 13 3% 12 8 20 – 29 year: 22%
70 and above 4 1% 7 3
Total 336 100% 156 () 180()
10 – 19 year: 18%
Common General Surgical Admissions
Common Surgical Specialty Neurology
• Head injury
Pediatric surgery
• Hirschsprung’s: 2
• Pyloric hyperplasia: 1
Orthopedic 81

admissions Fracture Dislocations Urology 7

BPH 6 Cystolithiasis 1 Plastic 11

Penile fibroma: 89 Harelip : 2 Dental 3

ENT Foreign body in-situ

Dental caries: 3
2 ear canal: 1

Nasal polyp: O&G C-section

1 74 15

TAH 9
General Surgical Subspeciality cases:
Operations: 136 200
60

50 48

40

30
30 27

20 17
14

10

0
others
Excision biopsy
Herniorrhaphy

Explo Laporotomy
Appendicetomy
Post-op Complications

what could
Action
Diagnosis Operation Complication have been
taken
done
re-explo,
explo- lap, irrigation
bowel and control sepsis
bowel resection/ delayed and optimize
obstruction/sepsis anastomosis wound break down closure well

secure enough
x-match prior to
grade 4 splenic injury splenectomy irreversible shock xmatch major cases
 Emergencies: 132 Elective Cases: 204
Common Emergencies Common Elective Cases
60
others 8
50 48
SPC 6
39
Debridment 44
40 36

splenectomy 2 30

craniotomy 5 18
20 16
13
I&D 11 8 9
10
5
2 2 3 3
herniorrhapy 9
0

explo lap 17

appendicectomy 30

0 10 20 30 40 50
 Types of surgeries
Emergency vs elective cases
400

350

300

250
204

200

150
124
100

132
50 53 27
68
24 40
0
emergency/elective minor intermediate major
Operations trend
Completion rate: 96% Cancellation reasons
Cancelation rate: 4%
400

350
350 336
time factor 2
300

250
faciity factor 4
200

150
staff factor 1
100

50
patient factor 7
14
0
total booked total done total cancelled 0 1 2 3 4 5 6 7 8
 CONSULTS
Urology ,

Referrals & consults Dental, 2 2

Referral in Peadiatric
40 Surg, 1
35
35 O&G, 2

30 Neurology
,1
25
Referral out
20
1.2
1 1 1 ENT, 1 Orthopedi Hepatobili
1
cs, 1 ary, 1
0.8
15
0.6

10 9 0.4

6 5
0.2
0
5 3 3 0
Referral in: 63
0

NFD MFD SFD Hela WSP West

Referral out: 3
Papua Consults: 12
Mortality: POM 4, POMR 1%, MR 3%

NAME AGE/SEX DOA Diagnosis DOD Expected/ Unexpected

Kopsi Soi m/30 13/01/21 (4am) Severe HI 13/01/21 (6am) Expected

Wen Timothy 16/m 1/2/21 Advanced retinoblastoma 15/02/21 Expected

Tabua Warua 29/m 2/2/21 Severe contused left lung 3/2/21 Unexpected

Sibona Mabo 44/F 16/05/21 Sepsis, uncontrolled DM with complications 18/05/21 Expected

Sapole Karopei 60/F 28/05/21 Pulmonary Emboli 30/05/21 Unexpected

Daniel Job 35/m 01/07/21 Basal skull fracture 02/7/21 Unexpected

Kupe Dupe 39/m 26/06/21 Sev sepsis 04/07/21 Unexpected

Lovai Bo 13/m 23/07/21 Advanced osteosarcoma 28/07/21 Expected

Peter Tabuni 59/m 19/09/21 Sev head injury 21/09/21 Expected

Jirah Joel m/2 23/10/21 Oro-phrayngeal injury 23/10/21 unexpected

Chris Thimoty m/36 28/11/21 Splenic Injury 29/11/21 Unexpected

Out-Patient Clinics
Surgical Out patient Clinic

reviews 632

new arrivals 1047

total 1679

0 200 400 600 800 1000 1200 1400 1600 1800

 Common Surgical
Conditions ranking the The table below shows the Top ten (10)
Common Surgical Conditions ranked
Top 10 Conditions in from highest to lowest.
SOPC (NB: *Others cover the less or rare Surgical Conditions)

Common Surgical Conditions Jan Feb Mar Apr May Jun Jul Aug Sept Octo Nov Dec Total

Hernia 13 24 13 15 29 19 25 14 24 39 24 7 246

Lumps /Bumps 13 19 18 25 21 18 34 22 16 9 23 3 221

Fractures 21 15 25 17 18 26 10 9 4 15 8 9 177

Appendicitis/Appendectomy 9 8 4 11 14 0 10 9 4 2 8 7 86

Wounds 2 0 13 4 0 0 0 2 0 15 20 3 59

BPH 8 5 8 6 8 0 4 0 0 6 4 0 49

Penile Fibroma 0 0 0 0 7 0 4 6 6 7 6 4 40

Cancer 3 6 3 0 4 0 3 0 7 6 0 3 35

K-wire insertion/removal 0 0 0 5 0 0 6 4 0 0 0 0 15

*Others 7 13 15 12 27 19 21 17 26 19 27 10 213
KRA 4: Address disease
burden and target health
priorities

• TB
• HIV
• Malaria
• Lifestyle disease

• Cancer
• Trauma
• Women's health
• Men's health
• Environment heath
• Preparedness to pandemics
KRA 4: Cancer: 37 SOPC, 17 admissions, 5 operations, 2 deaths
Malignancy deaths
Chemotherapy available: 2028
1. Methotrexate 2026
9

2. Tamoxifen 2024
6
4
2
2022
Way forward: 2021
2020 2020 deaths
More awareness and screening 2019
year
2018 2018
Early detection and proper referral
2016
pathway
2014

2012
Types of Malignancies 1 2 3 4

6
5
4

prostate Ca Breast Ca Bowel cervical

KRA 4: Trauma: admission: 191, operations: 142, 3 deaths
trauma in Northfly • Trauma is increasing in
year trauma cases
NFD
• So far only 3 deaths
176 183 170
191 ▪ Severe head injury
▪ Blunt abdominal
trauma
2018 2019 2020 2021 ▪ Splenic injury
▪ (all alcohol related
injuries)
1 2 3 4

Causes of trauma trauma vs non trauma

80 400

350
336
300

250
43 194
200
27 142
150
19
8 9 100
5
50

accidental bush knife MVA domestic sports pig bites alcohol 0

fall wounds violence injuries induced total operation total trauma non trauma
violence
KRA 4: Women's health Programs
Mortality 2
POMR 0
MR 1.9%

family planning trend

2250
213
2200
150
2150 133 132
2100
2050
2018 2019 2020 2021
2000
1950
1900
1 2 3 4

year FP
KRA 5: Strengthen health systems and governance

IT empowerment Drugs procurement

CMEs

Regular meetings New Orthopedics sets Accountability

 Logistics
• Debt and outstanding
• Delay in fundings & procurement of drugs
and equipment's
Administrative Manpower
Issues and • Need O&G and pediatrician
Shortages • Need 4 more registrars

Facility upgrade
• Upgrade to level 5
• Laboratory
• Digital x-ray system
Summary of baseline Audit Recommendations

• – in relation to overall observations by NHSS Assessment Teams:

➢ Working with Communities

➢ Health Workforce Planning and Management WPHA clinical
➢ Clinical Governance: Safe patient Care indicators in July
➢ Supervision and Outreach
➢ Patient Referrals achieved
➢ Medical Records
➢ Disease Outbreak Surveillance yet to achieve
➢ Clinical Audits
➢ Maternal, Perinatal, Neonatal, Paediatric Mortality &
Morbidity Committee
➢ Clinical Support Services
➢ Mental Health
➢ Assessment of Individual Health Facilities
Recommendations
Preparedness:
• less than 2 hours access to essential surgery
• 1 surgeon/10 000 population
Delivery :
• Improve surgical volume
• POMR below 3%
Impact :
• Promote sustainability, affordability and durability
• Provide Quality health care
Acknowledgment

WPHA/KDH/PARTNERS MEDICAL SERVICES HARD WORKING STAFF

FOR SUCCESFULL 2021 TEAM OF KDH