K Cohen1, S Bruijns. 1. Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa. kirstenlcohen@gmail.com.
Abstract
BACKGROUND: Data measured as key performance indicators (KPIs) are used internationally in emergency medicine to measure and monitor quality of care. The Department of Health in the Western Cape Province, South Africa, introduced time-based KPIs for emergency centres (ECs) in 2012. OBJECTIVES: To describe the most recently processed results of the audits conducted in Western Cape ECs between 2013 and 2014. METHODS: A retrospective, descriptive study was conducted on data collected in the 6-monthly Western Cape EC triage and waiting time audits for 2013 - 2014. Time variables were analysed overall and per triage category. ECs in hospitals were compared with ECs in community health centres (CHCs). A descriptive analysis of the sample was undertaken. Proportions for categorical data are presented throughout. The continuous variable time was described using means and standard deviations. The χ2 test and Fisher's exact test were used to describe associations. The level of significance was p<0.05, with the 95% confidence interval where appropriate. RESULTS: There was no significant difference in triage acuity proportions between hospital and CHC ECs. Waiting times were longer than recommended for the South African Triage Scale, but higher-acuity patients were seen faster than lower-acuity patients. Waiting times were significantly longer at hospitals than at CHCs. A red priority patient presenting to a CHC would take 6.1 times longer to reach definitive care than if the patient had presented to a hospital EC. CONCLUSIONS: The triage process appears to improve waiting times for the sickest patients, although it is protracted throughout. Acutely ill patient journeys starting at CHC ECs suggested significant delays in care. Models need to be explored that allow appropriate care at the first point of contact and rapid transfer if needed. To improve waiting times, resource allocation in the emergency care system will need to be reconsidered.
BACKGROUND: Data measured as key performance indicators (KPIs) are used internationally in emergency medicine to measure and monitor quality of care. The Department of Health in the Western Cape Province, South Africa, introduced time-based KPIs for emergency centres (ECs) in 2012. OBJECTIVES: To describe the most recently processed results of the audits conducted in Western Cape ECs between 2013 and 2014. METHODS: A retrospective, descriptive study was conducted on data collected in the 6-monthly Western Cape EC triage and waiting time audits for 2013 - 2014. Time variables were analysed overall and per triage category. ECs in hospitals were compared with ECs in community health centres (CHCs). A descriptive analysis of the sample was undertaken. Proportions for categorical data are presented throughout. The continuous variable time was described using means and standard deviations. The χ2 test and Fisher's exact test were used to describe associations. The level of significance was p<0.05, with the 95% confidence interval where appropriate. RESULTS: There was no significant difference in triage acuity proportions between hospital and CHC ECs. Waiting times were longer than recommended for the South African Triage Scale, but higher-acuity patients were seen faster than lower-acuity patients. Waiting times were significantly longer at hospitals than at CHCs. A red priority patient presenting to a CHC would take 6.1 times longer to reach definitive care than if the patient had presented to a hospital EC. CONCLUSIONS: The triage process appears to improve waiting times for the sickest patients, although it is protracted throughout. Acutely ill patient journeys starting at CHC ECs suggested significant delays in care. Models need to be explored that allow appropriate care at the first point of contact and rapid transfer if needed. To improve waiting times, resource allocation in the emergency care system will need to be reconsidered.