Factors that contribute to long waiting time for emergency centre patients: a waiting room case study of Paarl hospital, Western Cape

[摘要] ENGLISH SUMMARY : Background: Long waiting time for patients at emergency centres globally is having a negative impact on service delivery to patients and family members. The aim of this study was to explore and investigate factors that contribute to long waiting time for emergency centre patients at a Regional hospital in the Western Cape, South Africa. The objectives of the study were to elicit patients, family members, medical and nursing management as well as healthcare staff experiences, concerns and proposals to improve waiting time at the emergency centre. The Health Research Ethics committee at Stellenbosch University gave approval for the study as did the Western Cape Government Health and the Chief Executive Officer of Paarl Hospital to conduct the study at the emergency centre.Methods: A multi-method case study design with a qualitative descriptive approach was used by conducting in-depth individual interviews with patients, family members, healthcare staff and interviews with key role players from the emergency centre. A total of (n=18) participants took part in the study. A self-developed, semi-structured interview guide with open-ended questions and probes were used during data collection. Member checking took place during interviews by clarifying and summarizing participants' information during interviews. Qualitative data analysis was applied to the transcripts, which were coded for emerging themes. Five main themes emerged during data analysis. The first theme, 'The system that keeps us in the waiting game' was around the factors that contribute to long waiting time at the emergency centre. The second theme, 'The waiting room puzzle' focused on participant's experiences of being puzzled and confused about long waiting time. The third theme, 'The waiting game drain' emerged from the draining effect that the long waiting time has on healthcare staff working in the emergency centre. The fourth theme, 'The rules for the waiting game' encompassed the conceptual-framework driving healthcare which emerged during data collection and which was developed for this research study. The final theme, 'The waiting game plan' presents proposals from all participants to improve long waiting time at the emergency centre.Results: The findings of the study showed as in other studies that a shortage of staff and patient overload contribute to long waiting time. In addition, the study also found that inefficiencies in patient flow and inappropriate use of the emergency centre are causes that contribute to long waiting time for patients at the emergency centre. The recommendations are to align the emergency centre healthcare staff to the needs of the community. Presently, given the shortage of healthcare staff, the capacity to manage patients at the emergency centre is compromised. Discussions are required with District health services to render 24-Hour services to patients at a clinic or community health centre, where services are currently only rendered on weekdays until 16h00 and not over weekends or public holidays. Patient flow should be analysed and quality improvement systems such as Lean explored for efficiency gains. Education of patients and family members on triage and the appropriate use of the emergency centre is required. The expectation is that with this knowledge, waiting time will improve for patients needing emergency care.

[发布机构] Stellenbosch University