Introducing a New Investigation Sheet at Almanagil Teaching Hospital in Sudan: A Quality Improvement Project

Abstract

BACKGROUND: Incomplete medical documentation threatens patient safety and efficiency. At Almanagil Teaching Hospital (Sudan), baseline audits revealed only 21% completeness of investigation forms. AIM: This study aimed to increase documentation completeness from 21% to ≥90% within six weeks through a standardized investigation sheet and staff training. METHODS: A prospective observational quality improvement project (May-June 2025) applied two Plan-Do-Study-Act (PDSA) cycles. Cycle 1 audited 50 forms to assess baseline practice. Interventions included a redesigned standardized sheet, educational workshops, laminated samples, and posters. Cycle 2 audited 51 forms to assess improvement and gather feedback. Completeness was defined as the proportion of eligible fields documented. Two auditors independently reviewed 20% of forms (κ = 0.89). Because samples were independent, Pearson χ² and two-proportion z-tests were used, with Holm-Bonferroni correction for multiple comparisons. Effect sizes were reported with 95% confidence intervals. Run charts tracked weekly progress. Balancing measures included form completion time and laboratory turnaround. RESULTS: Mean completeness increased from 21.7% (95% CI: 14.5-28.9) to 94.2% (95% CI: 91.1-97.3) (p < 0.001). Improvements were seen across patient identifiers (0-40% → 100%) and critical labs (12-14% → ≥98%). Median form completion time increased slightly (3.2 → 3.7 minutes; p = 0.12), with no change in laboratory turnaround (2.0 → 2.1 hours; p = 0.64). Staff feedback informed refinements, including urgent flags and color-coded fields. CONCLUSIONS: A standardized sheet with training and audit cycles significantly improved documentation completeness. Sustainability measures include weekly audits, documentation champions, rejection of incomplete forms, quarterly refresher training, and electronic medical record integration.