Trends of adult admissions in a district hospital in Limpopo Province
Date
2011-11-11
Authors
Lourens, Adriaan Eksteen
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Abstract
BACKGROUND: District hospitals play an intermediary role between primary
health care (PHC) clinics and community health centres; (CHC), (predominantly
run by nurses) and regional hospitals, (predominantly run by specialists and
doctors). However, in the absence of efficient and adequate network of PHC clinics
and CHC’s, district hospitals often have to render these services. In addition, due
to geographic distances between district hospitals and regional hospitals, it often
has to offer specialist services such as Orthopaedics, Gynaecology, as well. This
increases the burden on district hospitals. The profile of patients admitted to district
hospitals have not been clearly described and this study seeks to describe and to
compare trends over a two year period and factors influencing these trends, to
allow for informed decisions to be made for future planning. No formal study on the
trends for admissions to District hospitals have been conducted, as far as could be
determined, and this study aimed to look into and describe the trends of
admissions over a two year period from April 2007 to March 2009, to allow for
informed decisions to be made to guide future plans.
AIM: To determine the trends of adult admissions in a district hospital in Limpopo
Province.
METHODOLOGY: A cross-sectional study design was used for this study. A
descriptive retrospective review of existing hospital records was conducted from
routine information captured on the MEDICOM patient administration system and
in ward and OPD/casualty registers. No intervention was done for this study.
The setting was F. H. Odendaal Hospital in Modimolle, which is a district hospital
situated in a rural area of the Limpopo Province. It serves a catchments population
of over 103 000 people. Data was collected from 4481 admitted adult patients from
which a random sample (n=800) was selected consisting of males (n=400) and
females (n=400). Data on variables such as the case load (number of adult
admissions during the research period), patient profile (gender, age, hospital
classification and geographic location) and clinical profile (mode of admission, agnoses and associated ICD-10 code/s as well as the mode of discharge) were
collected.
RESULTS: This study revealed that this hospital experienced an increase number
of adult admissions during the two years study period. During the same period it
could reduce the length of stay, thereby improve usable bed utilisation rate. This
reflected in more discharges and less death. This was probably due to availability
of more experienced medical officers and the fact that outreach services has been
conducted on a weekly basis by doctors and Clinical Support Services since
2008/09 financial year.
The majority of the patients who were admitted over the study period were Africans
residing in and around Modimolle. The majority was also classified as H1, meaning
that most of the patients admitted to this hospital are capable of paying the nominal
fee for services. The institution experienced an increase in the number of
admission over the two years by 11.7%. The mean age was 42.5 years for adults.
Of the top 5 diseases/conditions for which patients were admitted, Pneumonia,
Diarrhoea and Gastroenteritis, Retrovirus infections and Diabetes Mellitus were
present for both males and females. Although this disease pattern persists for a
number of years, it seems as if services provided manage to reverse discharge
trends as more patients were discharged home in the second year than in the first
year and the mortality rate decreased by 4.5% for adults between the two years.
CONCLUSION: Information obtained through this research could be extrapolated
to other district hospitals for the management of services, including the
management of beds. It could also serve as the basis for future research, as a
reference base to students and the teaching of students.