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Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa

INTRODUCTION: Crowding is a significant challenge for emergency centres (ECs) globally. While South Africa is not alone in reckoning with high patient demand and insufficient resources to treat these patients; staff-to-patient ratios are generally lower than in the Global North. The study of crowdin...

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Autores principales: van de Ruit, Catherine, Lahri, Sa'ad, Wallis, Lee A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: African Federation for Emergency Medicine 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320195/
https://www.ncbi.nlm.nih.gov/pubmed/32612908
http://dx.doi.org/10.1016/j.afjem.2019.12.004
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author van de Ruit, Catherine
Lahri, Sa'ad
Wallis, Lee A.
author_facet van de Ruit, Catherine
Lahri, Sa'ad
Wallis, Lee A.
author_sort van de Ruit, Catherine
collection PubMed
description INTRODUCTION: Crowding is a significant challenge for emergency centres (ECs) globally. While South Africa is not alone in reckoning with high patient demand and insufficient resources to treat these patients; staff-to-patient ratios are generally lower than in the Global North. The study of crowding and its consequences for patient care is a key research priority for strengthening the quality and efficacy of emergency care in South Africa. The study set out to understand frontline staff's perspectives on crowding in Cape Town public ECs to learn how they cope in such high- pressure working conditions, determine what they see as the factors contributing to crowding, and obtain their recommendations for reform. METHODS: This research is a qualitative study from interviews and observations at five ECs in Cape Town, conducted in June and July 2017. In total 43 staff were interviewed individually or in pairs. The interviews included physicians of varying levels of experience (25), and registered or enrolled nurses (18). Data were analysed with the qualitative text-analysis software NVivo. RESULTS: Both doctors and nurses saw crowding as a consequence of three factors: 1) limited bed space in the EC, 2) insufficient health professionals to care for admitted patients, and 3) the presence of boarders. Systemic or organizational factors as well as human resource scarcity were determined to be the key reasons for crowding. DISCUSSION: With its high patient acuity and volume and its limited human and material resources, South Africa is an important case study for understanding how emergency care providers manage working in crowded conditions. The solutions to crowding recommended by interviewees were to expand the EC workforce and to add discharge lounges and examination tables.
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spelling pubmed-73201952020-06-30 Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa van de Ruit, Catherine Lahri, Sa'ad Wallis, Lee A. Afr J Emerg Med Original Article INTRODUCTION: Crowding is a significant challenge for emergency centres (ECs) globally. While South Africa is not alone in reckoning with high patient demand and insufficient resources to treat these patients; staff-to-patient ratios are generally lower than in the Global North. The study of crowding and its consequences for patient care is a key research priority for strengthening the quality and efficacy of emergency care in South Africa. The study set out to understand frontline staff's perspectives on crowding in Cape Town public ECs to learn how they cope in such high- pressure working conditions, determine what they see as the factors contributing to crowding, and obtain their recommendations for reform. METHODS: This research is a qualitative study from interviews and observations at five ECs in Cape Town, conducted in June and July 2017. In total 43 staff were interviewed individually or in pairs. The interviews included physicians of varying levels of experience (25), and registered or enrolled nurses (18). Data were analysed with the qualitative text-analysis software NVivo. RESULTS: Both doctors and nurses saw crowding as a consequence of three factors: 1) limited bed space in the EC, 2) insufficient health professionals to care for admitted patients, and 3) the presence of boarders. Systemic or organizational factors as well as human resource scarcity were determined to be the key reasons for crowding. DISCUSSION: With its high patient acuity and volume and its limited human and material resources, South Africa is an important case study for understanding how emergency care providers manage working in crowded conditions. The solutions to crowding recommended by interviewees were to expand the EC workforce and to add discharge lounges and examination tables. African Federation for Emergency Medicine 2020-06 2020-02-18 /pmc/articles/PMC7320195/ /pubmed/32612908 http://dx.doi.org/10.1016/j.afjem.2019.12.004 Text en © 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
van de Ruit, Catherine
Lahri, Sa'ad
Wallis, Lee A.
Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa
title Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa
title_full Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa
title_fullStr Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa
title_full_unstemmed Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa
title_short Clinical teams' experiences of crowding in public emergency centres in Cape Town, South Africa
title_sort clinical teams' experiences of crowding in public emergency centres in cape town, south africa
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7320195/
https://www.ncbi.nlm.nih.gov/pubmed/32612908
http://dx.doi.org/10.1016/j.afjem.2019.12.004
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