Before BREATHE: A baseline audit of hypoxemia in Malawi
Abstract
Executive summary
4.1 Type of research study
The study is a prospective audit.
4.2 Problem to be addressed
Our team’s study at Queen Elizabeth Central Hospital (QECH) in 2012 showed tha one third of
medical patients had a respiratory diagnosis, and hypoxia was not identified in 21% of these.
Furthermore, only one third of those requiring oxygen by WHO guidelines were receiving it.1z
Due to the COVID-19 pandemic, interest in improving outcomes for all hypoxemic patients in
LICs has increased, with proposals including increases in oxygen supplies, improvements in
systems for monitoring hypoxemia and titrating oxygen therapy, and testing of various
oxygen delivery devices.
This audit will provide updated information on the practices, and outcomes for oxygen
monitoring and titration at QECH. The information collected for this audit will provide the
necessary platform from which future quality improvement and research studies can be
developed. Parallel data collection will occur in Rwanda and Kenya as part of the assessment
of potential sites for a prospective trial of high flow oxygen.
4.3 Broad objective
To understand oxygen supply and demand at Queen Elizabeth Central Hospital, Malawi.
4.4 Specific objectives
1. To describe the physical resources and current practices for oxygen therapy for
hypoxemic adults at QECH.
2. To measure the baseline performance of key indicators for optimal oxygen
monitoring, documentation, and titration.
3. To assess in-hospital outcomes of mortality and length of stay for all hypoxemic adults.
4.5 Methodology
Prospective audit of data recorded in the patient medical notes and charts. The audit will
continue for three months to give information on an estimated 300 patients (based on local
patterns), which will allow confidence in the representativeness, and ability to detect low
levels of non-compliance with hospital guidelines. To estimate mortality, this number gives a
5.7% precision around a prior estimate of 50%.16-Sep-2022
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4.6 Findings and dissemination
Data collected by the audit team will be freely available to, and owned by, the hospital. We
hope that this will allow an assessment of current practice, and inform repeated quality-
improvement cycles. The audit data will be used to power a future randomised controlled
trial of alternative (high flow) oxygen therapy. We will work with our team to present the
findings to hospital grand rounds, and to publish, for example, in the Malawi Medical Journal.
We will also feedback directly to COMREC.