An analysis of Inter-Healthcare Facility Transfer of Neonates within the eThekwini Health District of KwaZulu-Natal; South Africa

OBJECTIVES:To investigate delays in the transfer of neonates between healthcare facilities and to detect any adverse events encountered during neonatal transfer.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 (Durban) of KwaZulu-Natal Province; South Africa. Data collection was via questionnaire. Data collection was restricted to the Emergency Medical Service(EMSs) of eThekwini Health District; which is the local public ambulance provider.RESULTS:All transfers were undertaken by road ambulances: 83 (62.2%) by frontline ambulances; 35 (29.2%) by the obstetric unit; and 2 (1.7%) by the planned patient transport vehicles. Twenty-nine (24.2%) transfers involved critically ill neonates. The mean (standard deviation (SD)) time to complete an inter-healthcare facility transfer was 3 h 49 min (1 h 57 min) (range 0 h 55 min - 10 h 34 min). Problems with transfer equipment were common due to poor resource allocation; malfunctioning equipment; inappropriate equipment for the type of transfer and dirty or unsterile equipment. The study identified 10 (8.3%) physiologically related adverse events; which included 1 (0.8%) death plus a further 18 (15.0%) equipment-related adverse events.CONCLUSIONS:EMS is involved in transporting a significant number of intensive care and non-intensive care neonates between healthcare facilities. This study has identified numerous factors affecting the efficiency of inter-facility transfer of neonates and highlights a number of areas requiring improvement

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

Rising Caesarean Section Rates: an Audit of Caesarean Sections in a Specialist Private Practice

Background: Caesarean section (C/S) rates are increasing world wide; rates in the private sector in South Africa are reported to be particularly high. To the best of our knowledge; there has not been a recent audit of caesarean sections from the private health sector in KwaZulu-Natal. The aim of this study was to carry out an audit of C/S in a private practice. Methods: An audit of the patient records over a period of one year was done. No personal identifiers were noted or reported on. All relevant clinical data was pooled and used to analyse clinical information. Results: There were 364 deliveries in the study period and 209 of these were C/S; giving a rate of 60.4. The majority of the C/S were done for a previous C/S; maternal request and HIV status also contributed to the high rate. Conclusion: The high C/S rate in private practice is probably a window of the increased caesarean section rates world wide. This high rate is in keeping with trends in countries such as South America; and is much; much higher than the ideal rate in low-risk obstetric populations of 10.15suggested by the WHO