Workload and casemix in Cape Town emergency departments

Little is known about the nature of patients presenting to Emergency Departments (ED) in South Africa. This study aimed to provide evidence regarding the ED usage in Cape Town, by studying patients at four Community Health Centre (CHC) EDs, with details of the severity of their presentation and their disposal. A total of 16392 patients presented in the eight week study, and 15681 were included in data analysis. One quarter were children. There were clear and predictable peaks in attendance after 1600 hours and at weekends, with a steady stream of patients presenting overnight. Patient severity was evenly distributed between Emergency, Urgent and Routine care. Nearly 10% of patients were referred on to a higher level of care. The data of this study presents a model for staffing and resource allocation. It has implications for the provision of emergency care in CHC EDs

Workload and casemix in Cape Town emergency departments

Introduction. Little is known about the nature of patients presenting to emergency departments (EDs) in South Africa. This study aimed to provide evidence on ED usage in Cape Town by studying patients at four community health centre (CHC) EDs, with details of the severity of their presentation and their disposal. Methods. A total of 16 392 patients presented in this 8-week prospective observational study, and 15 681 were included in the descriptive data analysis. One-quarter were children. Results. There were clear and predictable peaks in attendance after 16h00 and at weekends, with a steady stream of patients presenting overnight. Case severity was evenly distributed between emergency, urgent and routine care. Nearly 10% of patients were referred on to a higher level of care. Conclusion. The data from this study present a model for staffing and resource allocation. It has implications for the provision of emergency care in CHC EDs

Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan

Background. Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low- and middle-income countries this strategy is underused, under-resourced and poorly researched.Objective. To assess the inter- and intra-rater reliability and accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in an emergency department (ED) in Timergara, Pakistan.Methods. Fifteen ED nurses assigned triage ratings to a set of 42 reference vignettes (written case reports of ED patients) under classroom conditions. Inter-rater reliability was assessed by comparing these triage ratings; intra-rater reliability was assessed by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings. Accuracy of the nurse ratings was measured against the reference standard.Results. Inter-rater reliability was substantial (intraclass correlation coefficient 0.77; 95% confidence interval (CI) 0.69 - 0.85). The intra-rater agreement was also high with 87% exact agreement (95% CI 67 - 100) and 100% agreement allowing for a one-level discrepancy in triage ratings. Overall, the SATS had high specificity (97%) and moderate sensitivity (70%). Across all acuity levels the proportion of over-triage did not exceed the acceptable threshold of 30 - 50%. Under-triage was acceptable for all except emergency cases (66%).Conclusion. ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for ‘very urgent’ and ‘routine’ cases, importantly, it may under-triage ‘emergency’ cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed

Characterizing the cancer genome in lung adenocarcinoma

Somatic alterations in cellular DNA underlie almost all human cancers(1). The prospect of targeted therapies(2) and the development of high-resolution, genome-wide approaches(3-8) are now spurring systematic efforts to characterize cancer genomes. Here we report a large-scale project to characterize copy-number alterations in primary lung adenocarcinomas. By analysis of a large collection of tumours ( n = 371) using dense single nucleotide polymorphism arrays, we identify a total of 57 significantly recurrent events. We find that 26 of 39 autosomal chromosome arms show consistent large-scale copy-number gain or loss, of which only a handful have been linked to a specific gene. We also identify 31 recurrent focal events, including 24 amplifications and 7 homozygous deletions. Only six of these focal events are currently associated with known mutations in lung carcinomas. The most common event, amplification of chromosome 14q13.3, is found in similar to 12% of samples. On the basis of genomic and functional analyses, we identify NKX2-1 ( NK2 homeobox 1, also called TITF1), which lies in the minimal 14q13.3 amplification interval and encodes a lineage-specific transcription factor, as a novel candidate proto-oncogene involved in a significant fraction of lung adenocarcinomas. More generally, our results indicate that many of the genes that are involved in lung adenocarcinoma remain to be discovered.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62944/1/nature06358.pd

Workload and casemix in Cape Town emergency departments

Introduction. Little is known about the nature of patients presenting to emergency departments (EDs) in South Africa. This study aimed to provide evidence on ED usage in Cape Town by studying patients at four community health centre (CHC) EDs, with details of the severity of their presentation and their disposal. Methods. A total of 16 392 patients presented in this 8-week prospective observational study, and 15 681 were included in the descriptive data analysis. One-quarter were children. Results. There were clear and predictable peaks in attendance after 16h00 and at weekends, with a steady stream of patients presenting overnight. Case severity was evenly distributed between emergency, urgent and routine care. Nearly 10% of patients were referred on to a higher level of care. Conclusion. The data from this study present a model for staffing and resource allocation. It has implications for the provision of emergency care in CHC EDs

Developing a reference standard for assessing paediatric triage scales in resource poor settings

One of the main challenges for emergency healthcare services in low to middle income countries (LMICs) is limited capacity to deal with heavy emergency caseloads. The process of triage is one mechanism for mitigating this challenge. Methods: In a two-round consensus building process (the Delphi process), a panel of emergency centre (EC) experts were asked to independently triage 50 clinical vignettes using one of four acuity levels: emergency (patient to be seen immediately), very urgent (patient to be seen within 10 min), urgent (patient to be seen within 60 min), or routine (patient to be seen within four hours). The vignettes were based on real paediatric EC cases in South Africa. Vignettes that reached a minimum of 80% group consensus for acuity ratings on either round one or two were included in the final set of reference vignettes. Results: Of the 50 vignettes presented to 11 EC experts, in the first round, 80% group consensus on acuity ratings was obtained for 10 (20%) of the vignettes. In the second round, 80% consensus was reached for 30 of the 40 remaining vignettes. Thus, overall, 40 (80%) of the vignettes reached a minimum group consensus of 80% (emergency n = 4; very urgent n = 8; urgent n = 12; routine n = 16). Conclusion: This study demonstrates how context-specific reference vignettes can be developed to provide a cheap, effective, and feasible means by which to evaluate paediatric triage systems in LMICs