Improving Clerkship to Enhance Patients’ Quality of Care (ICEPACQ): A Baseline Study

Abstract Background : Proper and complete clerkship of patients has long been shown to contribute to correct diagnosis and improved care of patients. All sections for clerkship must be carefully and completely done, to guide the diagnosis and the plan of management; moreover, one section guides the next. Failure to perform a complete clerkship has been shown to lead to misdiagnoses with its unpleasant outcomes like delayed recovery, prolonged inpatient stay, high cost of care and at worst death. Objective: The objectives of the study are; to determine the gap in clerkship of patients admitted, treated and discharged at the gynecological ward in Mbale RRH, the impact of incomplete clerkship on the length of hospital stay of the patients, to explore the causes of the gap in clerkship of the patients and the strategies which can be used to improve clerkship of the patients. Methodology: This was a mixed methods study involving collection of secondary data by review of patients’ files and collection of qualitative data by key informant interviews. The files of patients who were admitted from August 2022 up to December 2022, treated and discharged were reviewed by use of a data extraction tool. Data analysis was done using STATA version 15 by descriptive statistics, while qualitative data was analyzed by deductive thematic analysis using Atlas ti version 9. Results: Data was collected from 612 patient files. Social history had the most participants with no information provided at all (83.5 % not captured), with biodata and vital sign examination (20% not captured) having the least number. On patients’ biodata, at least each parameter was captured in all the patients, with the most gap noted in capturing the nearest health facility of the patient (91 % not captured). In the past history, the most gap was noted in the history of current pregnancy (37.5 % not provided at all); however, there was also a big gap in the past gynecological history (71 % not captured at all), past medical history (71 % not captured at all), past surgical history (73 % not captured at all) and family history (80% not captured at all). The physical examination had the most gap on abdominal examinational (43 %), with also substantial gaps in general examination (38.5 % not captured at all) and vaginal examination (40.5 % not captured at all) and vital sign examination having the least gap. There is no patient that received a complete clerkship. There was a significant association between clerkship and the length of hospital stay. The causes of the gap in clerkship were multifactorial from those related to the hospital, those related to the health worker, those related to the health care system and those related to the patient. The strategies to improve the clerkship of patients also ranged from measures to be taken by the health care worker, measures to be taken by hospital and measures to be taken by the government. Conclusion and recommendation: There is a gap in clerkship of patients on the gynecological ward, that is recognized by the stakeholders on the ward, with some components of clerkship captured better than others, with no patients that received a complete clerkship. There was a significant association between clerkship and the length of hospital stay. The following is recommended provision of clerkship tools, like the standardized clerkship guide and equipment for patient examination, continuous education of the health workers on clerkship and training them on how to use the available tools, developing SOPs for patient clerkship, promoting clerkship culture and supervision of the health workers.