Browsing by Author "Bruijns, Stevan Raynier"
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- ItemOpen AccessDevelopment of a model to address the content, process and communication aspects of emergency centre handover(2021) Makkink, Andrew William; Bruijns, Stevan Raynier; Stein Christopher AlexanderIntroduction: The emergency centre forms the first formal interaction between the prehospital and inhospital phases of the patient care continuum. There are several variables that have the potential to affect handover efficacy. Poor handover has been associated with an increase in sentient events and a risk to patient safety. This thesis aimed to investigate the perceptions of the practice of patient handover between prehospital emergency care providers and the emergency centre. This information was used to generate a model that addresses identified aspects of the emergency centre handover, namely content, process, and communication. Methods: The methodology followed a sequential, explanatory, mixed-methods design. Data were collected from prehospital emergency care personnel (PECP) and emergency centre personnel (ECP) in the Johannesburg area of South Africa. Study One and Study Two formed the quantitative and qualitative data collection phases respectively. Study One formed the quantitative component of the study using a survey that utilised a crosssectional, convenience design. Questionnaires were compiled de novo using data sourced from a search of major databases and were pilot tested prior to distribution. Questionnaires contained a mix of Likert-type, forced binary and open-ended questions. Questionnaires were distributed using a purposive, convenience strategy where potential participants were approached at their place of work. Data were analysed descriptively and reported on. The responses to the open-ended questions were used to compile the interview schedule used in Study Two. Study Two formed the qualitative approach of the thesis and used a qualitative descriptive design. Questions for Study Two were compiled using the results of the coding, analysis and interpretation of the responses to the open-ended questions from the paper-based questionnaire. Data were collected from 15 PECP and 15 ECP using face-to-face, semi structured interviews. Participants were approached using a purposive strategy and, where consent was obtained, were interviewed in a location that was conveniently available and afforded an adequate amount of privacy. Interviews were transcribed and then analysed using Computer-Assisted Qualitative Data Analysis Software Atlas.ti. Data were read and reread, coded and analysed to identify categories and themes that were then reported. A code-recode strategy ensured trustworthiness. Results: Handover content variables were ranked according to the perceived level of importance by prehospital emergency care and ECP. Physiological variables dominated the ten most important variables for both PECP and ECP. Handover quality was perceived by both PECP and ECP as requiring improvement. Less than half of both PECP and ECP had been exposed to formal handover training. Mnemonic knowledge was generally poor, and the most familiar mnemonic used by PECP was unfamiliar to the ECP. The same was true for the mnemonic most familiar to the ECP. Process factors that had the potential to affect the efficacy of emergency centre handover included repetition of information and having to hand over multiple times. The busyness of the emergency centre and the noisy environment associated with it were linked to compromised patient privacy and a distractive environment in which to hand over. Understaffing and overworked staff were identified as barriers to an effective handover process and contributors to some of the identified issues related to poor emergency centre handover. There were several communication factors identified by both PECP and ECP that negatively affected handover efficacy. Verbal, non-verbal and paraverbal cues were identified as having he potential to act as facilitators of or barriers to effective emergency centre handover. Listening skills were identified as a barrier to effective handover by both PECP and ECP. Interprofessional communication and relationships were identified as important for effective emergency centre handover. Using the data, a novel model was developed using an iterative process. The model proposes solutions to some of the content, process and communication problems that were identified in this thesis. The model sees handover as comprising of five phases of information flow and unlike many previous models, recognises the bidirectional nature of communication within the handover process. Conclusion: Emergency centre handover between PECP and ECP needs improvement. The novel model proposed in this thesis divides handover into phases, each of which has identified factors that have the potential to act as facilitators of or barriers to effective handover. The model has potential to be implemented in emergency centre handover environments and may also have relevance in other patient handover environments.
- ItemOpen AccessExploring the factors underlying successful publication following participation in an Author Assist service(2016) Banner, Megan; Bruijns, Stevan Raynier; Jacquet, Gabrielle AAuthor Assist is an initiative of the African Journal of Emergency Medicine (AfJEM) that pairs an experienced researcher with an author recently rejected for publication to assist with revision of the rejected article. This study explores the factors of the assistance process within partnerships that have achieved successful publication after resubmission and blind peer-review. It aims to improve Author Assist's ability to facilitate successful publication by identifying potential areas of focus that impact individual researcher development. A grounded theory, qualitative approach first looks at the assistance process for seven individuals via semi-structured interview. Structured surveys with a wider sample size of authors then provide feedback on specific components of the process and inform recommendations for improvements to the programme. Interviews are analysed by deductive placement of themes into inductively-developed categories. Participant stories within the African acute care context tend to be consistent with available literature describing current global challenges in overcoming barriers to scientific research and publication. Recounts of the Author Assist process are overwhelmingly positive, and frame the programme as a worthwhile, albeit time consuming, initiative that makes a substantial difference in the professional development of individuals, their ability to take on mentorship roles themselves, and their future success in scientific publication. Inductive build-up from interviews of effective components of the process, and suggestions for progression of the programme are confirmed by responses from other past participants. Common themes arising from author feedback include perceived pressure by assistants to complete work on time amidst other career demands; the effectiveness of the partnerships in addressing issues of language, structure, and submission requirements; and the desire for the programme to encompass the full research process. Assistant themes tend to mirror those of the authors. In addition, assistants suggest a more involved manuscript assessment by the journal, prior to commissioning a partnership. Also suggested is a redesign of the assistant database to categorise by type of assistance offered, rather than by topic expertise. The findings from this study confirm Author Assist's unique niche within emergency care development, and its effectiveness in supporting individual research careers. A number of reasonable and low cost improvements to the programme have been put forward for AfJEM to improve ability to facilitate successful publication.
- ItemOpen AccessFrom anxiety to haemorrhage : describing the physiological effects that confound the prognostic inferences of vital signs in injury(2013) Bruijns, Stevan RaynierIncludes abstract. Includes bibliographical references.
- ItemOpen AccessPatient waiting times within public Emergency Centres in the Western Cape: describing key performance indicators with respect to waiting times within Western Cape Emergency Centres in 2013-2014(2017) Cohen, Kirsten Lesley; Bruijns, Stevan RaynierBackground: Much emphasis has been placed on Quality Measurements or Key Performance Indicators in Emergency Medicine. Internationally, KPI's are used to measure and improve quality of care, with a major emphasis on waiting times, measured as time-based KPI's. These times are related to the various stages of a patient journey through the Emergency Center. In South Africa this has not been routinely done. The Western Cape has conducted audits in recent years to measure these. This study aims to provide a snapshot of waiting times (specifically time to triage, time to doctor, time to disposition decision and time to departure from the EC) within Cape Town public sector Emergency Centres. Methods: This is a retrospective descriptive study of waiting times for all patients presenting to Emergency Centres in the Western Cape in 2013-2014, as per six monthly waiting times audits conducted by the Western Cape Department of Health. A wide variety of emergency centers were audited, from 24 hour clinics to larger acute hospital based ECs. Results: The proportional acuity difference between hospitals and CHC for the first random 100 folders were statistically no different. Arrival to triage times were universally longer than internationally accepted as safe. The mean time for all-comers across all facilities was just under an hour, the higher acuity patients were triaged significantly faster (half an hour) than the lower acuity patients (hour or more). This difference was significant for hospitals, with a non-significant trend for CHCs. At hospital ECs, green patients were triaged significantly faster than yellow patients; this was not the case at CHCs. The mean time from triage to clinician consultation for all-comers across all facilities (over two hours) was significantly longer at hospitals as compared to clinics. Time from triage to clinician consultation, per triage category, were longer than the SATS guide times, although higher acuity cases were seen faster than lower acuity cases in a stepwise fashion. Red patients waited nearly an hour on average, with no significant difference between hospitals and CHCs. Orange patients had to wait one to two hours; this was significantly longer at hospitals. The mean time from assessment and management to a disposal decision for all-comers was significantly longer at hospitals as compared to CHCs across all priorities. Green patients took a lot longer at hospital compared to CHCs. A similar pattern was seen for the disposition decision to leaving time. The mean total time was significantly longer at hospitals as compared to clinics. Orange and yellow cases stayed significantly longer at hospitals as compared to CHCs; red and green cases also stayed longer at hospitals as compared to CHCs, though this was not significant. Red cases appeared to stay the longest at CHCs. Conclusions: Patients attending CHCs and hospitals are of similar illness acuity, despite policies dictating that sicker patients should be seen at hospitals not CHC level. CHCs have limited packages of care (decision making investigations, management options and expertise), and can only manage patients to a defined level. Thus, it takes longer for patients who are moderately or very ill to be seen and sorted in a CHC than a hospital, as at a CHC they are generally referred onwards to a hospital. Their journey through the EC will then begin again, so that for sicker patients the time spent in ECs in this study is underestimated. Models need to be explored so that patients receive care at point of contact as far as possible. Since CHC-based ECs see as many patients who are as ill as those in hospitals, these should have similar resources to hospitals, so that only those requiring definite admission need to be referred onwards. Point of care testing, bedside ultrasound, appropriate medications and EM skills should all be available at facilities closest to the patients with emergency conditions. Green patients, the lowest acuity, also take longer to be seen and sorted at hospitals versus CHCs, because investigations are available that are then done as an emergency versus outpatient basis. Efficient and timely outpatient appointments would help mitigate this.
- ItemOpen AccessStandardisation and validation of a triage system in a private hospital group in the United Arab Emirates(2016) Dippenaar, Enrico; Bruijns, Stevan Raynier; Oliver, AlbertIntroduction: Upon inspection and evaluation of the Mediclinic Middle East emergency centres in the United Arab Emirates, inconsistencies related to triage were found. Of note, it was found that the use of various international triage systems within and between the emergency centres may have caused potentially harmful patient conditions. The aim of this thesis was to study the reliability and validity of existing triage systems within Mediclinic Middle East, and then to use these systems as a starting point to design, standardise and validate a single, locally appropriate triage system. This single triage system should be able to accurately and safely assign triage priority to adults and children within all of Mediclinic Middle East emergency centres. Methods: A System Development Life Cycle process intended for business and healthcare service improvement was expanded upon through an action research design. Quantitative and qualitative components were used in a five-part study that was conducted by pursuing the iterative activities set by an action research approach to establish the following: the emergency centre patient demographic and application of triage, the reliability and validity of the existing triage systems, a determination of the most appropriate triage system for use in this local environment and development of a best-fit novel triage system, establishment of validation criteria for the novel triage system, and determination of reliability and validity of the novel triage system within Mediclinic Middle East emergency centres. Results: Low-acuity illness profiles predominated the patient demographic; high acuity cases were substantially smaller in number. The emergency centres used a combination of existing international triage systems; this was found to be inappropriate for this environment. Poor reliability and validity performance of the existing triage systems led to the development of a novel, four-level triage system. This novel triage system incorporates early warning scores through vital sign parameters, and clinical descriptors. The novel triage system proved to be substantially more reliable and valid than the existing triage systems within the Mediclinic Middle East emergency centres. Conclusion: Through an initial systems analysis, it became clear that the Mediclinic Middle East emergency centres blindly implemented an array of international triage systems. Using an action research approach, a novel triage system that is both reliable and valid within this local environment was developed. The triage system is fit to be implemented throughout all the Mediclinic Middle East emergency centres and may be transposed to similar emergency centre settings elsewhere.