A patient flow system for antenatal primary healthcare facilities in the Frances Baard District, Northern Cape Province

[摘要] English: Long waiting times in primary healthcare (PHC) facilities is a major challenge for the National Department of Health. The aim of the study was therefore to develop a patient flow system which would reduce long waiting times for patients in antenatal PHC facilities in the Frances Baard District, Northern Cape Province.A quantitative, non-experimental design was used to collect data. A specifically compiled checklist was applied to audit 12 antenatal PHC facilities to identify aspects which should be included in a proposed patient flow system. Twenty-one (n=21) healthcare providers also participated in an 'in-action Delphi technique process to seek consensus with regard to the identified aspects. The consensus seeking target was �?60%. Subsequently, a patient flow system was compiled, based on the 'in-action Delphi technique process.The results of the audit checklist were discussed according to the main headings in the checklist of which the first was the need for a patient flow system. The major challenges in this regard are determined by the fact that only 50% (n=6) of PHC facility assessed had any form of patient flow system or an appointment system in place. Eight of the facilities (66.6%) regularly experience bottlenecks at reception and in waiting areas, observation and consultation rooms, and toilets and at the pharmacy. Secondly, a lack of human resources was identified. Eleven healthcare facilities (91.6%) did not have queue marshals to direct healthcare users and organize patient flow. During the study, 11 of the healthcare facilities (91.6%) experienced a shortage of professional nurses to render PHC. Only three healthcare facilities (25%) had a pharmacist assistant to dispense medication and professional nurses fulfilled this role. In the last instance, physical resources were also a problem. Ten of the healthcare facilities (83.3%) did not have computers, printers or Internet access. Nine of the facilities (75%) did not have the minimum equipment required to render proper basic antenatal care services. None of the healthcare facilities had a separate change room additional to the antenatal consultation rooms (n=12 100%). viiThe level of consensus with regard to the list of identified aspects to be included in patient flow system gained from the audit results was 67%. Although these respondents agreed on the required proposed aspects to be included, they were also given an opportunity to add additional aspects. The original list of aspects was extended by adding the additional aspects agreed upon. No consensus was reached in the ranking of the aspects in the proposed patient flow system (< 60%). Consensus was reached on 25 of final list of 27 aspects to be included in the patient flow system. As indicated, a final patient flow system was developed based on the research results.The following recommendations would require further consideration as well: All healthcare facilities need dedicated, trained queue marshals to direct and organized the varied healthcare users. If this is not possible, administrative personnel, nursing staff or volunteers must be trained to execute this task. More healthcare providers need to be scheduled during clinic peak times. Healthcare users need to be booked according to appointment dates and times, to prevent overcrowded facilities and bottlenecks in the morning. A separate changing room where the next patient can undress while the present patient is being attended to would be ideal to save time. Finally, all healthcare facilities should have the necessary equipment and material resources to render proper healthcare services. It is extremely time consuming to move between consultation rooms sharing equipment, and is frustrating for both the healthcare provider and the healthcare user. Each antenatal consultation room should have a telephone to arrange referrals immediately and to swiftly obtain laboratory results on which treatment can be selected.

[发布机构] University of the Free State