Does higher performance in a national licensing examination predict better quality of care? A longitudinal observational study of Ethiopian anesthetists

BACKGROUND

Ethiopia made a national licensing examination (NLE) for associate clinician anesthetists a requirement for entry into the practice workforce. However, there is limited empirical evidence on whether the NLE scores of associate clinicians predict the quality of health care they provide in low-income countries. This study aimed to assess the association between anesthetists' NLE scores and three selected quality of patient care indicators.

METHODS

A multicenter longitudinal observational study was conducted between January 8 and February 7, 2023, to collect quality of care (QoC) data on surgical patients attended by anesthetists (n = 56) who had taken the Ethiopian anesthetist NLE since 2019. The three QoC indicators were standards for safe anesthesia practice, critical incidents, and patient satisfaction. The medical records of 991 patients were reviewed to determine the standards for safe anesthesia practice and critical incidents. A total of 400 patients responded to the patient satisfaction survey. Multivariable regressions were employed to determine whether the anesthetist NLE score predicted QoC indicators.

RESULTS

The mean percentage of safe anesthesia practice standards met was 69.14%, and the mean satisfaction score was 85.22%. There were 1,120 critical incidents among 911 patients, with three out of five experiencing at least one. After controlling for patient, anesthetist, facility, and clinical care-related confounding variables, the NLE score predicted the occurrence of critical incidents. For every 1% point increase in the total NLE score, the odds of developing one or more critical incidents decreased by 18% (aOR = 0.82; 95% CI = 0.70 = 0.96; p = 0.016). No statistically significant associations existed between the other two QoC indicators and NLE scores.

CONCLUSION

The NLE score had an inverse relationship with the occurrence of critical incidents, supporting the validity of the examination in assessing graduates' ability to provide safe and effective care. The lack of an association with the other two QoC indicators requires further investigation. Our findings may help improve education quality and the impact of NLEs in Ethiopia and beyond.

Factors affecting completeness of anaesthetic record: a cross-sectional study

Background

Anaesthesia Information Management Systems (AIMS) are of critical importance for ensuring the comprehensive recording of anaesthesia data. This study aimed to investigate the factors influencing the completeness of anaesthetic records created by various healthcare professionals including anesthesiologists, nurse anaesthetists, residents/fellows, and anaesthetic nurse trainees.

Methods

Employing an online Google Forms questionnaire, this descriptive research focused on understanding the factors contributing to the completeness of anaesthetic records. The survey was distributed to all anaesthesia personnel in the department, comprising a total of 165 participants. The questionnaire encompassed three primary aspects:(1) personal information, (2) knowledge related to recording anaesthetic records, and (3) concerns related to achieving high-quality record-keeping. To assess completeness, anaesthetic record forms were evaluated based on the 2020 Medical Record Audit Guideline of Thailand's National Health Security Office, with a completeness rate exceeding 80% deemed acceptable. Spearman's rank correlation was employed to analyze the connections between the associated factors and completeness of anaesthetic records.

Results

From August to October 2021, 165 records were examined, indicating a completeness rate of 89.7%. Several factors exhibited significant correlations with the completeness of anaesthetic records. These included age (r = -0.223; P=0.004), job position (r = 0.44; P<0.001), years of anaesthesia experience (r = -0.208; P=0.007), experience in anaesthetic record training/teaching (r = 0.181; P=0.02), and attitude emphasizing high-quality record-keeping (r = 0.167; P=0.032).

Conclusion

While personal attributes emerged as pivotal factors influencing record completeness, continuous training and a collaborative attitude were identified as critical for maintaining sustainability and achieving record-keeping goals.