Emergency centre reorganization in preparation to the COVID-19 pandemic: A district hospital's dynamic adaptation response

The COVID-19 global pandemic forced healthcare facilities to put special isolation measures in place to limit nosocomial transmission. Cohorting is such a measure and refers to placing infected patients (or under investigation) together in a designated area. This report describes the physical reorganisation of the emergency centre at Khayelitsha Hospital, a district level hospital in Cape Town, South Africa in preparation to the COVID-19 pandemic. The preparation included the identification of a person under investigation (PUI) room, converting short stay wards into COVID-19 isolation areas, and relocating the paediatric section to an area outside the emergency centre. Finally, we had to divide the emergency centre into a respiratory and non-respiratory side by utilising part of the hospital's main reception. We are positive that the preparation and reorganization of the emergency centre will limit nosocomial transmission during the expected COVID-19 surge. Our experience in adapting to COVID-19 may have useful implications for ECs throughout South Africa and in low-and-middle income countries that are preparing for this pandemic

A descriptive analysis of emergency department overcrowding in a selected hospital in Kigali, Rwanda

Introduction:Emergency Centre (EC) overcrowding is a global concern. It limits timeous access to emergency care; prolongs patient suffering; compromises quality of clinical care; increases staff frustration and chances of exposing staff to patient violence and is linked to unnecessary preventable fatalities. The literature shows that a better understanding of this phenomenon may contribute significantly in coming up with solutions; hence the need to conduct this study in Rwanda.Methods:A quantitative descriptive design; guided by the positivist paradigm; was adopted in this study. Self-administered questionnaires were distributed to 40 nurses working in the EC. Only 38 returned questionnaires; thus making the response rate 95.Results:The findings revealed that EC overcrowding in Rwanda is characterised by what is considered as reasonable waiting time for a patient to be seen by a physician; full occupancy of beds in the EC; time spent by patients placed in the hallways waiting; and time spent by patients in waiting room before they are attended. Triggers of EC overcrowding were classified into three areas: (a) those associated with community level services; (b) those associated with the emergency centre; (c) those associated with inpatient and emergency centre support services. Discussion:A number of recommendations were made; including the Ministry of Health in Rwanda adopting a collaborative approach in addressing EC overcrowding with emergency trained nurses and doctors playing an active role in coming up with resolutions to this phenomenon; conducting research that will lead to an African region definition of EC overcrowding and solutions best suited for the African context; and increasing the pool of nurses with emergency care training

Severe road traffic injuries in Kenya, quality of care and access

Background: Road traffic injuries (RTI) are on increase in developing countries. Health care facilities are poorly equipped to provide the needed services. Objective: Determine access and quality of care for RTI casualties in Kenya. Design: Cross-sectional survey Setting: 53 large and medium size private; faith-based and public hospitals. Participants: In-patient road traffic crash casualties and health personnel in the selected hospitals were interviewed on availability of emergency care and resources. Onsite verification of status was undertaken. Results: Out of 310 RTI casualties interviewed; 72.3; 15.6and 12.2were in public; faith-based and private hospitals; respectively. Peak age of the injured was 15-49 years. First aid was availed to 16.0of casualties. Unknown persons transported 76.5of the injured. Police and ambulance vehicles transported 6.1and 1.4; respectively. 51.9reached health facilities within 30 minutes of crash and medical care provided to 66.2within one hour. 40.8of recipient facilities were adequately prepared for RTI emergencies. Conclusions: Most RTI casualties were young and from poor backgrounds. Training of motorists and general public in first aid should be considered in RTI control initiatives. Availability of basic trauma care medical supplies in public health facilities was highly deficient