Main Article Content

Auditing surgical service provision at a South African tertiary institution: Implications for the development of district services


G.L. Laing
D.L. Skinner
J.L. Bruce
C. Aldous
V. Govindasamy
S.R. Thomson
D.L. Clarke

Abstract

Background: The optimal management of resources within South African state  hospitals has been hampered by a paucity of data due to a lack of robust auditing information systems. This study reviews the use of a Hybrid Electronic Medical Record (HEMR) system to capture and aggregate data pertaining to the inpatient service demands on a South African tertiary surgical service. This dataset was used to analyse the appropriateness of tertiary surgical resource utilisation.
Methods: The HEMR system was implemented at Greys Hospital, in the city of  Pietermaritzburg, Kwa-Zulu Natal, South Africa on 1 January 2013. Inpatient data pertaining to surgical admissions and operative interventions were captured prospectively.  Following an 18-month study period, the data were extracted,  aggregated and analysed. The district referral hospitals were  mapped, and district surgical procedures performed within the tertiary center were identified and  quantified.
Results: 7314 patients were admitted and managed by the tertiary surgical service during the study period. The median patient age was 33 years (IQR 6.5–42.4 years). 59.7% were male and 40.3% were female. General, trauma and paediatric surgical admissions constituted 54.8%, 28.6% and 16.6% respectively.  Emergency admissions constituted 62.4% and elective  admissions 37.6%. Referral sources were captured for 6653 (91%) of the cohort. 4338 (65.2%) patients were referred from  district hospitals. The district hospital (Northdale) closest to Greys Hospital was responsible for 1675 (25.2%) of surgical  referrals. 4174 operative procedures were performed during the study period, 54.7% performed as an  emergency, 34.1%  electively and 11.2% semi-electively. The median waiting time for emergency operative intervention was 535 minutes (IQR  130–663). A total of 1272 (30.5%) operative procedures performed were assessed as district-level operations. The time  intervals of 07:00–07:59 and 17:00–17:59 were identified as the time periods during which the least number of emergency procedures were performed in the operating theatres.
Conclusion: The HEMR system enabled the Pietermaritzburg Metropolitan  Department of Surgery to quantify the burden of surgical disease and map district referral patterns. Thirty percent of operative procedures performed were assessed as  district-level operations. Potentially correctable deficits identified within the tertiary center were lengthy delays to emergency surgery and non-optimal theatre utilisation periods.

Journal Identifiers


eISSN: 2078-5151
print ISSN: 0038-2361