Patient waiting times within public Emergency Centres in the Western Cape: describing key performance indicators with respect to waiting times within Western Cape Emergency Centres in 2013-2014

Background: Much emphasis has been placed on Quality Measurements or Key Performance Indicators in Emergency Medicine. Internationally, KPI's are used to measure and improve quality of care, with a major emphasis on waiting times, measured as time-based KPI's. These times are related to the various stages of a patient journey through the Emergency Center. In South Africa this has not been routinely done. The Western Cape has conducted audits in recent years to measure these. This study aims to provide a snapshot of waiting times (specifically time to triage, time to doctor, time to disposition decision and time to departure from the EC) within Cape Town public sector Emergency Centres. Methods: This is a retrospective descriptive study of waiting times for all patients presenting to Emergency Centres in the Western Cape in 2013-2014, as per six monthly waiting times audits conducted by the Western Cape Department of Health. A wide variety of emergency centers were audited, from 24 hour clinics to larger acute hospital based ECs. Results: The proportional acuity difference between hospitals and CHC for the first random 100 folders were statistically no different. Arrival to triage times were universally longer than internationally accepted as safe. The mean time for all-comers across all facilities was just under an hour, the higher acuity patients were triaged significantly faster (half an hour) than the lower acuity patients (hour or more). This difference was significant for hospitals, with a non-significant trend for CHCs. At hospital ECs, green patients were triaged significantly faster than yellow patients; this was not the case at CHCs. The mean time from triage to clinician consultation for all-comers across all facilities (over two hours) was significantly longer at hospitals as compared to clinics. Time from triage to clinician consultation, per triage category, were longer than the SATS guide times, although higher acuity cases were seen faster than lower acuity cases in a stepwise fashion. Red patients waited nearly an hour on average, with no significant difference between hospitals and CHCs. Orange patients had to wait one to two hours; this was significantly longer at hospitals. The mean time from assessment and management to a disposal decision for all-comers was significantly longer at hospitals as compared to CHCs across all priorities. Green patients took a lot longer at hospital compared to CHCs. A similar pattern was seen for the disposition decision to leaving time. The mean total time was significantly longer at hospitals as compared to clinics. Orange and yellow cases stayed significantly longer at hospitals as compared to CHCs; red and green cases also stayed longer at hospitals as compared to CHCs, though this was not significant. Red cases appeared to stay the longest at CHCs. Conclusions: Patients attending CHCs and hospitals are of similar illness acuity, despite policies dictating that sicker patients should be seen at hospitals not CHC level. CHCs have limited packages of care (decision making investigations, management options and expertise), and can only manage patients to a defined level. Thus, it takes longer for patients who are moderately or very ill to be seen and sorted in a CHC than a hospital, as at a CHC they are generally referred onwards to a hospital. Their journey through the EC will then begin again, so that for sicker patients the time spent in ECs in this study is underestimated. Models need to be explored so that patients receive care at point of contact as far as possible. Since CHC-based ECs see as many patients who are as ill as those in hospitals, these should have similar resources to hospitals, so that only those requiring definite admission need to be referred onwards. Point of care testing, bedside ultrasound, appropriate medications and EM skills should all be available at facilities closest to the patients with emergency conditions. Green patients, the lowest acuity, also take longer to be seen and sorted at hospitals versus CHCs, because investigations are available that are then done as an emergency versus outpatient basis. Efficient and timely outpatient appointments would help mitigate this

Organic Diets Reduce Exposure to Organophosphate Pesticides

To determine whether consuming a largely organic diet reduces OP pesticide exposure in adults, a prospective, randomised, single-blinded, crossover, biomonitoring study was performed. The study involved 13 Australian adults who consumed a largely (>80%) organic diet or a largely conventional diet for 7 days and were then crossed over to the alternate diet for a further 7 days. Urinary levels of six dialkylphosphate (DAP) metabolites produced from OP pesticides, were analysed in first-morning voids collected on day 8 of each phase using GC-MS/MS, with limits of detection at 0.11-0.51 μg/L. Results, which were creatinine corrected to account for urine dilution or concentration, revealed that consumption of organic food for 7 days resulted in a statistically significant reduction in urinary OP metabolites. The mean total DAP results in the organic phase were 89% lower than in the conventional phase (M=0.032 and 0.294 respectively, p=.013). There was a significant 96% reduction in urinary dimethyl DAPs in the organic vs. conventional phase (M=0.011 and 0.252 respectively, p=.005), and a 49% reduction in diethyl DAPs which was not significant (M=0.021 and 0.042 respectively, p=.170). Overall the consumption of organic food resulted in a statistically significant reduction total DAPs and total dimethyl DAPs in urine indicating reduced exposure to organophosphate pesticides. Large scale studies are now required to confirm these results and determine their clinical relevance

History dependence of directly observed magnetocaloric effects in (Mn, Fe)As

We use a calorimetric technique operating in sweeping magnetic field to study the thermomagnetic history- dependence of the magnetocaloric effect (MCE) in Mn0.985Fe0.015As. We study the magnetization history for which a "colossal" MCE has been reported when inferred indirectly via a Maxwell relation. We observe no colossal effect in the direct calorimetric measurement. We further examine the impact of mixed-phase state on the MCE and show that the first order contribution scales linearly with the phase fraction. This validates various phase-fraction based methods developed to remove the colossal peak anomaly from Maxwell-based estimates.Comment: 4 pages, 2 figure

An analysis of the clinical practice of emergency medicine in emergency centres in the Western Cape

Includes abstract.Includes bibliographical references.To determine whether the current South African Emergency Medicine Curriculum is appropriate for the burden of disease seen by registrars in Cape Town Emergency Centres, a cross- sectional retrospective audit of 1283 clinical presentations from three secondary level ECs in Cape Town was done. The type of clinical presentations, investigations done and procedures per- formed were analysed. Basic descriptives are presented. The curriculum did not cover all the clinical conditions, procedures and investigations encountered by EM registrars in Cape Town. There were also multiple categories in the curriculum that were not encountered in EM practice at all. The investigations section correlated particularly poorly with the skills needed for the burden of disease seen in ECs in Cape Town. The curriculum should be redrafted guided by a practice analysis of EM

Psychometric Properties of the Family Caregiver Delirium Knowledge Questionnaire

A valid, reliable measure of family caregivers’ knowledge about delirium was not located in the literature; such an instrument is essential to assess learning needs and outcomes of education provided. The purpose of the current study was to (a) develop a family Caregiver Delirium Knowledge Questionnaire (CDKQ) based on the Symptom Interpretation Model; and (b) establish validity and reliability of the measure. The 19-item CDKQ was developed and administered to 164 family caregivers for community-dwelling older adults. Descriptive statistics were examined for all variables. Psychometric testing included confirmatory factor analysis, item-to-total correlations, and internal consistency reliability. A three-factor model provided the best fit for the data. The findings support initial validity and reliability of the CDKQ with family caregivers. Although the CDKQ was developed for use with family caregivers, it has potential for use with other caregivers, such as home health aides

The anomalous Hall effect in non-collinear antiferromagnetic Mn3_{3}NiN thin films

We have studied the anomalous Hall effect (AHE) in strained thin films of the frustrated antiferromagnet Mn$_{3}$NiN. The AHE does not follow the conventional relationships with magnetization or longitudinal conductivity and is enhanced relative to that expected from the magnetization in the antiferromagnetic state below $T_{\mathrm{N}} = 260$\,K. This enhancement is consistent with origins from the non-collinear antiferromagnetic structure, as the latter is closely related to that found in Mn$_{3}$Ir and Mn$_{3}$Pt where a large AHE is induced by the Berry curvature. As the Berry phase induced AHE should scale with spin-orbit coupling, yet larger AHE may be found in other members of the chemically flexible Mn$_{3}A$N structure

Spin polarized transport current in n-type co-doped ZnO thin films measured by Andreev spectroscopy

We use point contact Andreev reflection measurements to determine the spin polarization of the transport current in pulse laser deposited thin films of ZnO with 1% Al and with and without 2%Mn. Only films with Mn are ferromagnetic and show spin polarization of the transport current of up to 55 $\pm$ 0.5% at 4.2 K, in sharp contrast to measurements of the nonmagnetic films without Mn where the polarization is consistent with zero. Our results imply strongly that ferromagnetism in these Al doped ZnO films requires the presence of Mn.Comment: Published versio