3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item An assessment of the impact of injuries due to assaults, gunshots and motor vehicle accidents on the admissions and costs of the Orthopaedic department at Addington hospital in Durban(2004) Lutge, Elizabeth EleanorThis research report examined the epidemiology of trauma in the orthopaedic ward at Addington hospital, Durban, over the year 2000. It also quantified the financial cost of trauma to this ward over the same period of time, using the “bottom up” costing method. The cost of trauma was also calculated using the “top down” method, as well as using tariff charges (used to bill patients with medical aid attending public hospitals). The overall cost of trauma to this ward for 2000 was found to be R5 440 964.20. A constant relationship was found between the costs as calculated using the three methods above.Item Assessing litigation risks in patient-doctor interactions at Helen Joseph hospital(2017) Smith, Stephen DavidIntroduction: Medical malpractice lawsuits continue to be filed at an alarming rate, with billions of dollars being paid out across the globe. Most of these claims, defendable or not, are settled out of court. These uncontrolled medical claims continue to push up the costs of medical liability insurance, which in turn pushes up the cost of health care. These pressures are felt most by the "high risk" specialties namely, Obstetrics and Gynaecology, Neurosurgery and Orthopaedics. South Africa has not escaped the wave of medico-legal lawsuits, and may be headed towards greater challenges than its first world counterparts. With the introduction of the new Consumer Protection Act, and having one of the world's most enlightened constitutions, makes the South African medical fraternity an easy target. Litigation involving South African orthopaedic surgeons suggests that the majority of claims filed are due to poor patient-doctor interaction, accounting for 13.35% of all claims. Methodology: A prospective study conducted at Helen Joseph Hospital 2014. Using a tailored patient satisfaction questionnaire, post operative orthopaedic patients were able to give insight into their satisfaction regarding their personal patient-doctor interactions. Each question was correlated to an area of patient-doctor interaction, that in the past had led to litigation. This was used to asses which areas of patient-doctor interactions were lacking in a typical resource starved state hospital. Results: Nearly 20% of patients are considering legal action at point of discharge, with no demographic data playing any significant role in this decision. All areas of patient-doctor interactions showed a significantly lower score, in those considering litigation versus those who were not. The two highest risk areas were related to doctor availability and consent taking. This study emphasizes the importance of proper communication between doctors and patients in preventing litigation, and the need for doctors to focus on improving their individual doctor-patient relationships.Item Operational costing of inpatient orthopaedic services at the Helen Joseph Hospital(2012-01-17) Bogoshi, Gladys MagugudiBACKGROUND: Until recently budget allocation for public hospitals in the Gauteng Province were based on the historical values and not on the costed activities. It is therefore unknown how much of the allocated budget is used per discipline in an institution. Because of recurrent over expenditure by institutions, Gauteng Department of Health and Social Development have decided to change policy for budget allocation of funding public health facilities from historical allocation to activity based costing. Although good financial management of hospitals is a priority for the government, data on real costs of providing health care services is scarce and unreliable. No formal study has been done to estimate the cost to provide inpatient services in the Helen Joseph Hospital, a regional hospital in the Gauteng Province. In view of that, it was decided to initiate this study at the Orthopaedic unit of the Hospital, which would then be extended to the other units. AIM: To estimate the caseload, profile of patients and operational cost of providing the inpatient orthopaedics services at a regional hospital in Gauteng. METHODOLOGY: A cross-sectional study design was used based on retrospective review of patients’ and hospital records of patients admitted during one month study period at the two Orthopaedic Ward in the Helen Joseph Hospital, situated in the Johannesburg Health District in the Gauteng Province. RESULTS: Total number of patients admitted in the Orthopaedic Unit of the Hospital in the year 2009/2010 was 2160 (The mean number of inpatients per month was 180 ± 28). Profile of patients One hundred and ninety seven patients were admitted during one month study period. There were more male than female patients. The median age was 41 years (IQR 31-53 years). More black patients were admitted during this period, even though the main catchment population for the Hospital is predominantly white and coloured. The majority of patients were from a low socio-economic class as reflected by their classification for user fee payment using the means test. The median inpatient day was 3. The most common cause of admissions is due to injury, poisoning and certain other consequences of external causes as expected in an Orthopaedic Ward. A low complication rate (4.5%) was found to be the lowest as compared to other units in the Hospital. The majority of patients were discharged. Cost drivers The major cost driver was human resource which accounted for 70% of the total expenditure. Other cost drivers were material resources used in the unit, which includes: laboratory, blood and blood products, radiology and pharmaceuticals. Expenditure on these items account for only 13.7% of total expenditure. Cost driver Amount Unit cost Laboratory R61,215.57 R412.26 Blood and blood products R53,164.41 R269.87 Radiology R52,085.50 R264.39 Pharmaceuticals R17,315.82 R87.90 The total expenditure during this period was R 1,481,363.30 or R 17,776,359.60 annually. The unit cost of laboratory services (Ward 4: R926.30 and Ward 5: R272.97), blood and blood products (Ward 4: R463.05 and Ward 5: R217.52), radiology (Ward 4: R659.97 and Ward 5: R157.20) and pharmaceuticals (Ward 4: R236.63 and Ward 5: R47.60) and varied significantly between Ward 4 and Ward 5 which might be due to difference in clinical practices between the two Wards. CONCLUSION: This study showed the operational costs needed to provide an inpatient orthopaedic service at a regional health facility. Further study based on more detailed costing at individual patient level is necessary to develop a better understanding of costing at these Wards. This study highlighted the significance of understanding the importance of determining the actual costs needed to provide an inpatient service in a health facility. Simple cost analysis method could easily be done at Unit/ Ward level to provide more insight to Hospital managers who are always criticized for overexpenditure.Item Seroprevalence of HIV in acute Orthopaedic trauma at the Johannesburg Hospital(2011-11-03) Sefeane, Tatolo IshmaelThe principal aim of the study was to establish the HIV Seroprevalence in an acute Orthopaedic trauma setting in an urban teaching hospital. Secondary aims were (i), to establish if the seroprevalence compares with the national averages and findings from other similar studies, and (ii), to establish the effect of informed consent on the response rate to recruitment in HIV related studies. Methodology All illegible patients (able and qualified to give an informed consent for HIV testing) admitted to the Orthopaedic trauma unit at the Johannesburg hospital, were pre-counselled and tested for HIV after admission. Those that tested positive were then counselled again and referred accordingly to the HIV clinics for follow up. Results A total of 797 patients were admitted during the period. 159 (20%) did not meet the inclusion criteria, declined counselling or could not be counselled for various reasons. The main reason for non response was cited as a need to wait until after the acute event before they considered the test. A total of 648 patients were therefore eligible for recruitment. All patients were pre-counselled for the test and 246 (39%) consented and signed the informed consent form. Of those that were tested, 57 (23%) tested positive and were followed up accordingly. This result was then compared with previous non Orthopaedic studies on the HIV Seroprevalence. The rate of HIV infection in our acute orthopaedic trauma setting was found to be 23%. This is higher than the national averages but compares with other studies. Most acutely traumatized patients are not willing to be tested for HIV in the acute setting. This has a huge bearing on recruitment of suitable candidates for future studies in HIV in an acute trauma setting. Higher response rates to recruitment in HIV studies are directly proportional to the use of qualified counsellors in organized centres like the Voluntary Counselling and Testing centres.