Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa

CITATION: Van De Ruit, C., Lahri, S. & Wallis, L. A. 2020. Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa. African Journal of Emergency Medicine, 10(2):52-57, doi:10.1016/j.afjem.2019.12.004.The original publication is available at https://www.sciencedirect.com/journal/african-journal-of-emergency-medicineIntroduction: Crowding is a significant challenge for emergency centres (ECs) globally. While South Africa is not alone in reckoning with high patient demand and insufficient resources to treat these patients; staff-to-patient ratios are generally lower than in the Global North. The study of crowding and its consequences for patient care is a key research priority for strengthening the quality and efficacy of emergency care in South Africa. The study set out to understand frontline staff's perspectives on crowding in Cape Town public ECs to learn how they cope in such high- pressure working conditions, determine what they see as the factors contributing to crowding, and obtain their recommendations for reform. Methods: This research is a qualitative study from interviews and observations at five ECs in Cape Town, con- ducted in June and July 2017. In total 43 staff were interviewed individually or in pairs. The interviews included physicians of varying levels of experience (25), and registered or enrolled nurses (18). Data were analysed with the qualitative text-analysis software NVivo. Results: Both doctors and nurses saw crowding as a consequence of three factors: 1) limited bed space in the EC, 2) insufficient health professionals to care for admitted patients, and 3) the presence of boarders. Systemic or organizational factors as well as human resource scarcity were determined to be the key reasons for crowding. Discussion: With its high patient acuity and volume and its limited human and material resources, South Africa is an important case study for understanding how emergency care providers manage working in crowded condi- tions. The solutions to crowding recomme the EC workforce and to add discharge lounges and examination tables.https://www.sciencedirect.com/science/article/pii/S2211419X19301648?via%3DihubPublisher’s versio

Assessment of documented adherence to critical actions in paediatric emergency care at a district-level public hospital in South Africa

CITATION: Berends, E. A., et al. 2021. Assessment of documented adherence to critical actions in paediatric emergency care at a district-level public hospital in South Africa. African Journal of Emergency Medicine, 11(1):98-104, doi:10.1016/j.afjem.2020.09.001.The original publication is available at https://www.sciencedirect.com/journal/african-journal-of-emergency-medicineIntroduction The provision of high-quality care is vital to improve child health and survival rates. A simple, practice-based tool was recently developed to evaluate the quality of paediatric emergency care in resource-limited settings in Africa. This study used the practice-based tool to describe the documented adherence to critical actions in paediatric emergency care at an urban district-level hospital in South Africa and assess its relation to clinical outcomes. Methods This study is a retrospective observational study covering a 19-month period (September 2017 to March 2019). Patients <13 years old, presenting to the emergency centre with one of six sentinel presentations (seizure, altered mental status, diarrhoea, fever, respiratory distress and polytrauma) were eligible for inclusion. In the patients' files, critical actions specific for each presentation were checked for completion. Post-hoc, a seventh group ‘multiple diagnoses’ was created for patients with more than one sentinel disease. The action completion rate was tested for association with clinical outcomes. Results In total, 388 patients were included (median age 1.1 years, IQR 0.3–3.6). The action completion rate varied from 63% (polytrauma) to 90% (respiratory distress). Participants with ≥75% action completion rate were younger (p < 0.001), presented with high acuity (p < 0.001), were more likely to be admitted (adjusted OR 2.2, 95%CI: 1.2–4.1), and had a hospital stay ≥4 days (adjusted OR 3.4, 95%CI: 1.5–7.9). Conclusion A high completion rate was associated with young age, a high patient acuity, hospital admission, length of hospital stay ≥4 days, and the specific sentinel presentation. Future research should determine whether or not documented care corresponds with the quality of delivered care and the predictive value regarding clinical outcome.https://www.sciencedirect.com/science/article/pii/S2211419X20300987?via%3DihubPublisher’s versio

Adult medical emergency unit presentations due to adverse drug reactions in a setting of high HIV prevalence

South Africa has the world's largest antiretroviral treatment programme, which may contribute to the adverse drug reaction (ADR) burden. We aimed to determine the proportion of adult non-trauma emergency unit (EU) presentations attributable to ADRs and to characterise ADR-related EU presentations, stratified according to HIV status, to determine the contribution of drugs used in management of HIV and its complications to ADR-related EU presentations, and identify factors associated with ADR-related EU presentation. Methods: We conducted a retrospective folder review on a random 1.7% sample of presentations over a 12-month period in 2014/2015 to the EUs of two hospitals in Cape Town, South Africa. We identified potential ADRs with the help of a trigger tool. A multidisciplinary panel assessed potential ADRs for causality, severity, and preventability

The burden of HIV and tuberculosis on the resuscitation area of an urban district-level hospital in Cape Town

CITATION: Swarts, L., Lahri, S. & Van Hoving, D. J. 2021. The burden of HIV and tuberculosis on the resuscitation area of an urban district-level hospital in Cape Town. African Journal of Emergency Medicine, 11(1):165-170, doi:10.1016/j.afjem.2020.09.016.The original publication is available at https://www.sciencedirect.com/journal/african-journal-of-emergency-medicineIntroduction: Many patients present to emergency centres with HIV and tuberculosis related emergencies. Little is known about the influence of HIV and tuberculosis on the resuscitation areas of district-level hospitals. The primary objective was to determine the burden of non-trauma patients with HIV and/or tuberculosis presenting to the resuscitation area of Khayelitsha Hospital, Cape Town. Methods: A retrospective analysis was performed on a prospectively collected observational database. A randomly selected 12-week sample of data from the resuscitation area was used. Trauma and paediatric (<13 years) cases were excluded. Patient demographics, HIV and tuberculosis status, disease category, investigations and pro- cedures undertaken, disposition and in-hospital mortality were assessed. HIV and tuberculosis status were determined by laboratory confirmation or from clinical records. Descriptive statistics are presented and com- parisons were done using the χ2-test or independent t-test. Results: A total of 370 patients were included. HIV prevalence was 38.4% (n = 142; unknown n = 78, 21.1%), tuberculosis prevalence 13.5% (n = 50; unknown n = 233, 63%), and HIV/tuberculosis co-infection 10.8% (n = 40). HIV and tuberculosis were more likely in younger patients (both p < 0.01) and more females were HIV- positive (p < 0.01). Patients with tuberculosis spend 93 min longer in the resuscitation area than those without (p = 0.02). The acuity of patients did not differ by HIV or tuberculosis status. Infectious-related diseases and diseases of the digestive system occurred significantly more in the HIV-positive group, and endocrine-related diseases and diseases of the nervous system in HIV-negative patients. HIV-positive patients received more abdominal ultrasound examinations (p < 0.01), blood cultures (p < 0.01) and intravenous antibiotics (p < 0.01). In-hospital mortality was 17% and was not influenced by HIV status (p = 0.36) or tuberculosis status (p = 0.29). tuberculosis on the resuscitation area of a district level nor tuberculosis status were associated with in-hospital mortality.https://www.sciencedirect.com/science/article/pii/S2211419X20301130?via%3DihubPublisher’s versio