Browsing by Author "Hodkinson, Peter W"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Open Access
    Caregivers' experiences of pathways to care for seriously ill children in Cape Town, South Africa: A qualitative investigation
    (Public Library of Science, 2016) Jones, Caroline H D; Ward, Alison; Hodkinson, Peter W; Reid, Stephen J; Wallis, Lee A; Harrison, Sian; Argent, Andrew C
    Purpose Understanding caregivers' experiences of care can identify barriers to timely and good quality care, and support the improvement of services. We aimed to explore caregivers' experiences and perceptions of pathways to care, from first access through various levels of health service, for seriously ill and injured children in Cape Town, South Africa, in order to identify areas for improvement. METHODS: Semi-structured, qualitative interviews were conducted with primary caregivers of children who were admitted to paediatric intensive care or died in the health system prior to intensive care admission. Interviews explored caregivers' experiences from when their child first became ill, through each level of health care to paediatric intensive care or death. A maximum variation sample of transcripts was purposively sampled from a larger cohort study based on demographic characteristics, child diagnosis, and outcome at 30 days; and analysed using the method of constant comparison. RESULTS: Of the 282 caregivers who were interviewed in the larger cohort study, 45 interviews were included in this qualitative analysis. Some caregivers employed 'tactics' to gain quicker access to care, including bypassing lower levels of care, and negotiating or demanding to see a healthcare professional ahead of other patients. It was sometimes unclear how to access emergency care within facilities; and non-medical personnel informally judged illness severity and helped or hindered quicker access. Caregivers commonly misconceived ambulances to be slow to arrive, and were concerned when ambulance transfers were seemingly not prioritised by illness severity. Communication was often good, but some caregivers experienced language difficulties and/or criticism. CONCLUSIONS: Interventions to improve child health care could be based on: reorganising the reception of seriously ill children and making the emergency route within healthcare facilities clear; promoting caregivers' use of ambulances and prioritising transfers according to illness severity; addressing language barriers, and emphasising the importance of effective communication to healthcare providers.
  • Thumbnail Image
    Item
    Open Access
    The association between length of emergency department boarding and hospital length of stay for patients with mental health and behavioural disorders
    (2022) Hendrikse, Clint; Van Hoving, D J; Hodkinson, Peter W
    Background Psychiatric boarding in Emergency Departments is a global challenge. Patients with mental and behavioural disturbances are disproportionally affected with boarding times up to three times longer than other patients. This retrospective cross-sectional study investigated the impact of an initiative to reduce psychiatric boarding on length of stay and readmission rate, as well as exploring the relationship between boarding times and length of stay. Methods All adult patients referred over a 24-month period (June 2017 – May 2019) for psychiatric admission from the Emergency Department of a Cape Town district hospital were included. This included a 9-month period prior to the initiative, after which inpatient capacity was increased, and inpatient hallway boarding was implemented. Data relating to admission processes and outcomes were extracted from electronic registries. Results In total, 2607 patients were referred for psychiatric admission (2.7% of all Emergency Department patients). The initiative was associated with a decrease of 95% (56 vs 3 hours, p24-hour boarding category (351 vs 360 hours, p=0.047). The readmission rate increased from 12% to 18% post intervention. Conclusion A significant improvement in hospital length of stay and psychiatric boarding times occurred after the initiative was implemented. The benefits should be weighed up against a subsequent higher readmission rate. From a lean- and economical perspective, the results of this study suggest that psychiatric boarding equates to waste as it is independent of ward length of stay. The observational nature of this study precludes concrete conclusions and further investigations into psychiatric inpatient hallway boarding are recommended.