Exploring the sorting of patients in community health centres acroos Gauteng
Date
2018
Authors
Witt, Brenda
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Abstract
Background.
Primary health care facilities worldwide face large numbers of patients daily, as they are generally the first port of call for patients needing health care. Due to this, poor waiting times, low patient satisfaction, staff burnout etc. are some of the problems facing such facilities. Limited research has been done that looks at sorting of patients in non-emergency settings in Africa. There are several clinicians trying to sort patients in such settings in community health centres (CHC’s) across Gauteng but findings have not been documented. This research looked at this setting where queues appear to be poorly managed, with patients waiting for hours.
Aim.
To explore the views of clinicians in CHCs across Gauteng on sorting systems to manage walk-in patients in the non-emergency ambulatory setting.
Methods.
The qualitative study design utilized one-to-one, in-depth interviews of twelve purposively selected doctors. Interviews were conducted in English, with open-ended exploratory questions. Interviews were recorded and transcribed, anonymised and member checked. Data collection and analysis stopped with information saturation. The co-author supervised and cross-checked the process. A thematic framework was developed together, before final thematic coding was done by the principal author.
Results.
Twelve primary health care (PHC) clinicians with experience in patient sorting, from health districts across Gauteng, were interviewed. Three themes were identified, two major themes, namely Systems Implemented and Factors Affecting Triage and one minor theme, namely Innovative Suggestions. Systems Implemented included those using vital signs and sorting according to specialities, using the Integrated Management of Childhood Illnesses programme. Systems Implemented also included doctor - nurse triage, first come first serve, eyeball triage and sorting based on main complaint. Factors Affecting Triage, had three sub-themes: Management Issues, including equipment, documentation, infrastructure, protocol, uniformity, general management issues; and Staff Issues, including teamwork, buyin, education and general staffing issues; and Patient-related Factors. Innovative Suggestions, such as triage room treatment and investigations, telephone triage, longer clinic hours and a booking system emerged as minor themes.
Conclusion.
Developing a functional triage protocol for Gauteng is an important recommendation. However, correcting the issues of management and staffing needs to be integral to the development and implementation of this. It should ensure that staff training, communication, documentation, as well as roles and responsibilities are performed appropriately; and that adequate infrastructure and equipment are available to enable a successful system. Further research is required to develop standardized, validated tools to audit triage processes in the primary health care non-emergency outpatient setting.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Medicine, Johannesburg, 2018