The organisational response of a hospital critical care service to the COVID-19 pandemic: The Groote Schuur Hospital experience

Background. There are limited data about the coronavirus disease-19 (COVID-19)-related organisational responses and the challenges of expanding a critical care service in a resource-limited setting.Objectives. To describe the ICU organisational response to the pandemic and the main outcomes of the intensive care service of a large state teaching hospital in South Africa.Methods. Data were extracted from administrative records and a prospective patient database with ethical approval. An ICU expansion plan was developed, and resource constraints identified. A triage tool was distributed to referring wards and hospitals. Intensive care was reserved for patients who required invasive mechanical ventilation (IMV). The total number of ICU beds was increased from 25 to 54 at peak periods, with additional non-COVID ICU capacity required during the second wave. The availability of nursing staff was the main factor limiting expansion. A ward-based high flow nasal oxygen (HFNO) service reduced the need for ICU admission of patients who failed conventional oxygen therapy. A team was established to intubate and transfer patients requiring ICU admission but was only available for the first wave. Results. We admitted 461 COVID-19 patients to the ICU over a 13-month period from 5 April 2020 to 5 May 2021 spanning two waves of admissions. The median age was 50 years and duration of ICU stay was 9 days. More than a third of the patients (35%; n=161) survived to hospital discharge. Conclusions. Pre-planning, leadership, teamwork, flexibility and good communication were essential elements for an effective response. A shortage of nurses was the main constraint on ICU expansion. HFNO may have reduced the requirement for ICU admission, but patients intubated after failing HFNO had a poor prognosis.

An audit of the Day-of-Surgery Cancellation of Scheduled Surgical Procedures in Sagamu, Nigeria

Background: Timely performance of scheduled surgical procedures may be an indirect method of assessing the quality of surgical services in a hospital.Objective: This study aimed to determine the rate and the reasons for day-of-surgery cancellation of elective surgical procedures.Methods: A prospective study was conducted at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria to audit the type of surgery and the reasons for the cancellation of procedure among patients scheduled for elective surgical procedures.Results: A total of 1,324 patients were scheduled for elective surgeries during the period of audit and 268 (20.2%) were cancelled on the day of surgery. One hundred and seventy-four of the 268 (65.0%) cancellations were avoidable while 94 (35.0%) cancellations were unavoidable. The reasons for the cancellation of surgeries included patient-related factors (35.0%), unfavourable pre-operative clinical evaluation (31.0%), facility-based factors (28.0%) and surgeon-related factors (6.7%).Conclusion: The day-of-surgery cancellation rate was 20.2%, and the three leading causes of cancellation of elective surgeries in Sagamu included patient-related factors, unfavourable pre-operative clinical evaluation and inadequacies of hospital resources

Organisational Culture of Hospitals to Predict Turnover Intentions of Professional Nurses

The objective of this study was to determine if organisational culture predicts turnover intentions of professional nurses. A predictive model with organisational culture and various proposed mediating variables; namely knowledge sharing; organisational commitment; organisational citisenship behaviour and job satisfaction; as well as variousdemographic variables was developed to determine turnover intentions through applying General Linear Modelling. A correlational design with questionnaires was used. A sample of professional nurses (N = 530) in private and provincial hospitals was obtained. The results indicate that organisational culture has a significantly negative correlation withturnover intentions. Organisational culture also interacted with job satisfaction; knowledge sharing; and the white professional nurses' category to decrease turnover intentions and with Organisational Citisen Behaviours to increase turnover intentions in a final predictive model. It is therefore recommended that nursing employers seriously embarkon strategies to improve the organisational culture to retain their talent

Criteria for Appointing a Committee

Mulago Hospital is a large; national referral institution; employing 2300 workers and managing over 500;000 patients (78;000 in patients and 430;000 out patients per annum). These patients' treatment is the output of this hospital and their improvement is the outcome. To achieve this objective calls for a very organised structure; with a clear sense of direction and purpose at every stage of the production activity. Inputs firs the activities which generate products in our case effectively treated patients (Input Activities - Process - Output). Every area equires a clear understanding of the plans; policies; principles; guidelines and sometimes laws or statutory instruments governing operations; which in turn aim at optimum achievement of the set objectives; goals and ultimately the mission of the Institution. This statement appears heavily loaded; but its implication is simply that of a well-organised journey with a clear map; a sound and well-serviced vehicle whose various parts are continuously performing; a good driver; efficient guides (both human and dials on the dash board) and a known destination. There are many players; but each is well set in its department to contribute to movement towards the projected destination. Mulago is moving and for this it requires different types of players to lead it to its mission and ultimately its vision