Implementation of a structured paediatric admission record for district hospitals in Kenya – results of a pilot study

The PAR was primarily based on symptoms and signs included in the Integrated Management of Childhood Illness (IMCI) diagnostic algorithms. It was introduced with a three-hour training session, repeated subsequently for those absent, aiming for complete coverage of admitting clinical staff. Data from consecutive records before (n = 163) and from a 60% random sample of dates after intervention (n = 705) were then collected to evaluate record quality. The post-intervention period was further divided into four 2-month blocks by open, feedback meetings for hospital staff on the uptake and completeness of the PAR.The frequency of use of the PAR increased from 50% in the first 2 months to 84% in the final 2 months, although there was significant variation in use among clinicians. The quality of documentation also improved considerably over time. For example documentation of skin turgor in cases of diarrhoea improved from 2% pre-intervention to 83% in the final 2 months of observation. Even in the area of preventive care documentation of immunization status improved from 1% of children before intervention to 21% in the final 2 months.The PAR was well accepted by most clinicians and greatly improved documentation of features recommended by IMCI for identifying and classifying severity of common diseases. The PAR could provide a useful platform for implementing standard referral care treatment guidelines.A survey conducted to assess the performance of district hospitals in Kenya in the year 2002 demonstrated significant shortcomings in the care of admitted children [1]. One of the problems identified in the survey was that data required for even crude health systems performance indicators were of poor quality and potentially misleading. Such data are likely to prevent effective health care planning for the hospital, region and nation. Several studies have shown that introduction of structured admission forms improve documentation and performance of the health provider [2-4] a