The neonatal transfer process through the lens of neonatologists at public hospitals in South Africa

Background: Neonatal care is provided by various levels of healthcare facilities in South Africa. Intensive care for neonates is only provided at the higher levels, hence the need for transfers from lower-level to higher-level facilities (e.g. primary hospitals to tertiary hospitals) or across levels of facilities, particularly when life-threatening situations arise (e.g. cardiac deterioration, respiratory deterioration and desaturation). Aim: The aim of the study was to explore neonatologists' views regarding the neonatal transfer process and to describe the preparedness of advanced life support (ALS) paramedics to undertake such transfers. Setting: The setting consisted of neonatologists from three provinces i.e. KwaZulu-Natal, Gauteng and Western cape. Method: A qualitative descriptive design was utilised in this study. Semistructured interviews were conducted on the public health hospitals in three provinces (N = 9; n = 3) with neonatologists (N = 7; n = 7) who were involved in the transfers of critically ill neonates. The process of thematic analysis was used. Results: The themes that emerged in this study were: an awareness of local contextual realities related to neonatal transfers, challenges evident within the context of neonatal transfers, decision-making around the transfer of ill neonates, ALS paramedic preparedness for transfers and good clinical governance Conclusion: The study found that there was a need to be aware of local contextual realities confronting neonatal transfers, a need for greater preparedness for paramedics to undertake these transfers, a need for a sound referral processes and a need for coordinated transfer effort between paramedics, hospital staff and transport team members for the successful transfer of critically ill neonates. Contribution: The findings highlight the challenges confronting the neonatal transfer process in South Africa through the lens of neonatologist at public hospitals. Hence, the study reinforces the preparedness and coordination of the transfer process, along with more efficient communication between paramedics, hospital staff and the transfer team.

The association between hospital arrival time, transport method, prehospital time intervals, and in-hospital mortality in trauma patients presenting to Khayelitsha Hospital, Cape Town

Introduction:Trauma is a leading cause of unnatural death and disability in South Africa. The aim of the study was to determine whether method of transport, hospital arrival time or prehospital transport time intervals were associated with in-hospital mortality among trauma patients presenting to Khayelitsha Hospital, a district-level hospital on the outskirts of Cape Town, South Africa.Methods:The Khayelitsha Hospital Emergency Centre database was retrospectively analysed for trauma-related patients presenting to the resuscitation area between 1 November 2014 and 30 April 2015. Missing data and additional variables were collected by means of a chart review. Eligible patients' folders were scrutinised for hospital arrival time, transport time intervals, transport method and in-hospital mortality. Descriptive statistics were presented for all variables. Categorical data were analysed using the Fisher's Exact test and Chi-square, continuous data by logistic regression and the Mann Whitney test. A confidence interval of 95% was used to describe variance and a p-value of <0.05 was deemed significant.Results:The majority of patients were 19­44 year old males (n = 427, 80.3%) and penetrating trauma the most frequent mechanism of injury (n = 343, 64.5%). In total, 258 (48.5%) patients arrived with their own transport, 254 (47.7%) by ambulance and 20 (3.8%) by the police service. The arrival of trauma patients peaked during the weekend, and was especially noticeable between midnight and six a.m. In-hospital mortality (n = 18, 3.4%) was not significantly affected by transport method (p = 0.26), hospital arrival time (p = 0.22) or prehospital transport time intervals (all p-values >0.09). Discussion:Method of transport, hospital arrival time and prehospital transport time intervals did not have a substantially measurable effect on in-hospital mortality. More studies with larger samples are suggested due to the small event rate

Attitudes of prehospital providers on transport decision-making in the management of patients with a suicide attempt refusing care: a survey based on the mental health care act of 2002

Background: Given the frequency of suicidal patients making attempts prior to a completed suicide, emergency access to mental health care services could lead to significant reduction in morbidity and mortality for these patients. Aim: To describe the attitudes of prehospital providers and describe transport decision-making around the management of patients with a suicide attempt. Setting: Cape Town Metropole. Methods: A cross-sectional, vignette-based survey was used to collect data related to training and knowledge of the Mental Health Care Act, prehospital transport decision-making and patient management. Results: Patients with less dramatic suicidal history were more likely to be discharged on scene. Few respondents reported the use of formal suicide evaluation tools to aid their decision. Respondents displayed negative attitudes towards suicidal patients. Some respondents reported returning to find a suicidal patient dead, while others reported patient attempts at suicide when in their care. Eighty per cent of respondents had no training in the management of suicidal patients, while only 7.0% had specific training in the Mental Health Care Act. Conclusion: A critical lack in the knowledge, training and implementation of the Mental Health Care Act exists amongst prehospital providers within the Western Cape. A further concern is the negative feelings towards suicidal patients and the lack of commitment to transporting patients to definitive care. It is essential to urgently develop training programmes to ensure that prehospital providers are better equipped to deal with suicidal patients

An analysis of inter-healthcare facility transfer of neonates within the ethekwini health district of KwaZulu-natal

Objectives: To assess the time frames for the inter-healthcare facility transfer of neonates and investigate the factors that may have led to delays in the transfer; and investigate any adverse events encountered during the transfer of the neonate. Methods: A prospective study was conducted from December 2011 to January 2012. A quantitative, non-experimental design was used to undertake a descriptive analysis of 120 inter-healthcare facility transfers of neonates within the eThekwini Health District of KwaZulu-Natal. Data collection relied upon two questionnaires.Results: All the transfers were undertaken by road ambulances of which 83 (62.2%) by the operational ambulance units, 35 (29.2%) by the obstetric unit and 2 (1.7%) by the planned patient transport units. Twenty nine (24.2%) were specialised transfers. The mean time ± standard deviation (SD) to complete an inter-healthcare facility transfer was 3 h 49 min±1 h 57 min with the minimum time of 5 min and the maximum time of 10 h 34 min. Equipment required for neonatal transport was a major problem due to poor resource allocation, and malfunctioning, inappropriate, insufficient and unsterile equipment. The study identified 10 (8.3%) physiological related adverse events which included 1 (0.8%) death and 18 (15.0%) equipment related adverse events. Conclusions: The EMRS eThekwini Health District is involved in the transportation of a significant number of intensive care and non-intensive

"Appropriate Health Transport in Rural Africa: A Case Study of ""ENGOZI"" in South Western Uganda."

"Bsckground: The study was carried out in the mountains South Western part of Uganda. The residents are predominantly agricultural subsistence farmers. Lack of transport is a serious problem in this area; the road network is poor and very few vehicles are available. The transport problems are coupled with minimal economic activities and lack of cash. In an effort to respond to these problems; a local solution has been the ""ENGOZI"" or basket stretcher for carrying patients. Objectives: This study was undertaken in order to ""examine a system of health transport that utilises appropriate technology and is affordable to the community""."

Transport Policy for Health Services in the Public Health Sector: Lessons Learned from a Study of the Impact on Health Services of Public-Private Partnership for Transport in the Eastern Cape

Adequate and appropriate vehicles are essential for health service delivery. These are required for transport and transfer of patients from community to health facilities and between levels of health care delivery of essential equipment; medicines and other supplies to point of service delivery transport of health workers for supervisory visits; to attend meetings and training sessions and for administrative purposes. A transport management system that is efficiently and cost effectively run is essential to ensure availability of vehicles for health service delivery when required

Transport for Health Care Delivery

The lack of transport to ensure timeous transfer of patients between levels of health care facilities and for delivery of medicines; vaccines; and other essential equipment is a commonly heard cry from health workers; particularly from those working in rural areas; but is often overlooked and rarely researched. It is essential to have the correct vehicle mix and a sound transport management system to ensure efficient and effective health service delivery. Public sector transport policies and management systems in South Africa are complex. Policy decisions for the management of the national fleet are set by the national Department of Transport; remote from the level of service delivery. The provincial departments of Transport lease vehicles for service delivery to user departments; such as the Department of Health. A Fleet Management Service Provider is contracted to the national Department of Transport to coordinate fuel and oil purchases and maintenance of the national fleet. Management of the national fleet has been identified by the national Department of Transport (NDoT) as not being part of the core business of the department. The policy direction of the NDoT is to outsource the management of the national fleet; (as has been done in the Northern Cape Province); and improve the subsidised car scheme for public servants. How these policy decisions will affect health service delivery is not known; particularly within a decentralised health system. This chapter explores some of the complexities of the present transport management systems for health service delivery within the public sector through three provincial case studies; namely Limpopo; Mpumalanga and Gauteng. Some recommendations for improved management and for further research are made

Transport management: A key component of effective health care

Transport is not only an expensive resource; but is also critical to effective health care delivery. A lack of transport and the poor use of existing vehicles can lead to problems such as poor supplies of drugs to clinics; inadequate supervision of clinic staff; difficulties in referring patients between facilities; infrequent visits to schools by the school health team; and a lack of community outreach health services or mobile clinic services. The ISDS experience suggests that it is imperative for district health services to focus on developing good management for transport. It is one of the most important functions of a district health management team (DHMT); and adequate time must be spent improving performance and educating users

Supporting staff through effective supervision: How to assess; plan and implement more effective clinic supervision

This Kwik-Skwiz addresses the important area of clinic supervision. This document is aimed at district management teams clinic supervisors and programme managers may find it especially useful. Key areas of effective supervision are presented with the aim of assisting district management teams to critically assess clinic supervision in your district