Introduction Surgical services are increasingly seen to reduce death and
disability in Sub-Saharan Africa, where hospital-based mortality remains
alarmingly high. This study explores two implementation approaches to improve
the quality of perioperative care in a Tanzanian hospital. Effects were
compared to a control group of two other hospitals in the region without
intervention. Methods All hospitals conducted quality assessments with a
Hospital Performance Assessment Tool. Changes in immediate outcome indicators
after one and two years were compared to final outcome indicators such as
Anaesthetic Complication Rate and Surgical Case Fatality Rate. Results
Immediate outcome indicators for Preoperative Care in the intervention
hospital improved (52.5% in 2009; 84.2% in 2011, p<0.001). Postoperative
Inpatient Care initially improved to then decline again (63.3% in 2009; 70% in
2010; 58.6% in 2011). In the control group, preoperative care declined from
50.8% (2009) to 32.8% (2011, p <0.001), while postoperative care did not
significantly change. Anaesthetic Complication Rate in the intervention
hospital declined (1.89% before intervention; 0.96% after intervention, p =
0.006). Surgical Case Fatality Rate in the intervention hospital declined from
5.67% before intervention to 2.93% after intervention (p<0.0010). Surgical
Case Fatality Rate in the control group was 4% before intervention and 3.8%
after intervention (p = 0.411). Anaesthetic Complication Rate in the control
group was not available. Discussion Immediate outcome indicators initially
improved, while at the same time final outcome declined (Surgical Case
Fatality, Anaesthetic Complication Rate). Compared to the control group, final
outcome improved more in the intervention hospital, although the effect was
not significant over the whole study period. Documentation of final outcome
indicators seemed inconsistent. Immediate outcome indicators seem more helpful
to steer the Continuous Quality Improvement program. Conclusion Specific
interventions as part of Continuous Quality Improvement might lead to
sustainable improvement of the quality of care, if embedded in a multi-faceted
approach
