Ruth Laryea is the Research and Administrative Assistant at the Neurology, Stroke, and Renal Dialysis Units at Korle Bu Teaching Hospital, Accra. She carries out audits to support the monitoring activities of the partnership between Wessex UK and Korle Bu Teaching Hospital
My name is Ruth Laryea and I am a research assistant for the Neurology Unit, stroke unit, and renal dialysis unit at KBTH and I started in September 2012. When I was employed, I immediately started working for the project. Before that I was working for the University of Ghana Medical School doing informal technical work.
My role is to input the data on stroke cases from the four medical wards at KBTH. I am also the administrative assistant and so in addition to the audit work that I do, I handle all the correspondence, send messages/memos to other departments, and requests for things we need. I also play a role relating information between the individual teams, helping to bring them together.
I go round the wards to collect the data on stroke cases then I enter the data into a computer and add the stroke checklist data that has been filled in by the physician and nurses. When I started this role, I used a private laptop to enter the data but now the department has a computer. We also have a paper-based stroke diary and I enter the data in there as well.
We have four medical wards here and each one admits stroke cases. Each ward has a nurses’ station where they keep the admissions and discharges book and when I go to the ward, I take this book and I go through it looking at the primary diagnoses. Whenever I see stroke, I take down all the information that I need on them for example, when they were admitted and when they were discharged. I take this information down on some sheets that have specific data fields that I need to complete. I fill the sheets in on the wards and then I enter the data into Excel on the computer in my office. If I go to the wards once a week, it will take me 30 minutes per ward although it depends on how many cases are on the ward.
The reason that I do this audit for the project is because most people who come to the hospitals with stroke leave with morbidities or they die so we are trying to see how the care of stroke patients influences the outcome of their stay in hospital. At first we were just looking at the figures for who died and who was discharged. The Wessex team helped us to create a sheet in Excel to work out the percentages of deaths and when I started working here there wasn’t anything like that, I just entered the data.
There is one ward dedicated to stroke patients – the neurology ward – so sometimes we compare the outcomes on this ward with the outcomes on other wards. Patients on the neurology ward have a higher chance of survival and now we have more concrete evidence for this. Every month we discuss the mortality of the previous month at a meeting for all the medical staff. Stroke comes up a lot in these meetings and we discuss the care given to these patients. These meetings are the only platform to discuss these issues but our department is looking into setting up more meetings so that we have more opportunity to talk about the issues. In addition to these meetings, we send the data by email to the UK team twice a year and when they visit, they review it and check what more information we have.
I have a BSc in Biochemistry and I did some research for my BSc so I had the qualifications to take on the research assistant role and I’ve not had additional training. Now along with other research assistants, we are asking for training on data analysis so that we can do more interpretation of the data we collect.
My motivation for doing the audit work is that I like answering questions. If the information we get is then put into practice it is very rewarding. At the moment, the results are not very conclusive but may be with more data and more analysis, this could be better but at the moment, there is not enough information. For example, we only look at who got discharged and who died but the outcome data we collect could be more detailed. We have discussed it and we are going to put extra outcome information on the discharge sheet for example, if someone has a stroke and gets a facial deformity and other morbidities, by the time they leave, we want to know how much recovery have they reached, not just whether they have died or been discharged. We think that with this information, we can know the real outcome of a patient’s case.
Sometimes the data that I collect on the wards is incomplete for example, it will say that the patient has been discharged, there will be a comment of ‘satisfactory’ but no further data on the patient’s outcomes. So when there are holes in the data I collect, I go to other sources to see if I can get more information such as from the account records. I am hoping that with the dedicated stroke unit opening, such challenges will be taken care of.
Read more about the Wessex UK - KBTH partnership's approach to monitoring in this good practice case study.