Causes and outcomes of intensive care admission refusals: A retrospective audit from a rural teaching hospital in Eastern Cape, South Africa
- Ninise, Ezile Julie, Mrara, Busisiwe
- Authors: Ninise, Ezile Julie , Mrara, Busisiwe
- Date: 2023/06
- Subjects: ICU triage , Refusal rates , Nelson Mandela Academic Hospital , A retrospecive cross-sectional study
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/11260/13200 , vital:78090 , DOI: https://doi.org/10.3390/clinpract13040066
- Description: (1) Background: Patients who deserve intensive care unit (ICU) admission may be denied due to a lack of resources, complicating ICU triage decisions for intensive care unit (ICU) clinicians. Among the resources that may be unavailable are trained personnel and monitored beds. In South Africa, the distribution of healthcare resources is reflected in the availability of ICU beds, with more ICU beds available in more affluent areas. Data on ICU refusal rates, reasons for refusal, patient characteristics, and outcomes are scarce in resource-constrained rural settings. Hence, this study sheds light on the ICU refusal rates, reasons for refusal, characteristics, and outcomes of refused patients at NMAH. (2) Methods: This was a three-month retrospective cross-sectional record review of refused and admitted patients from January to March 2022. COVID-19 patients and those younger than 13 years old were excluded. Refusal rates, reasons for refusal, characteristics, and outcomes of refused patients were analysed quantitatively using SPSS VS 20 software. Reasons for refusal were categorised as “too well”, “too sick”, and “suitable for admission but no resources”. (3) Results: A total of 135 patients were discussed for ICU admission at NMAH during the study period; 73 (54.07%) were refused admission, and 62 (45.92%) were admitted. Being considered too sick to benefit from ICU was the most common reason for refusal (53.23%). Too well and no resources contributed 27.42% and 19.35%, respectively. Patients with poor functional status, comorbidities, medical diagnoses, and those referred from the ward or accident and emergency unit rather than the operating room were more likely to be refused ICU admission. Refused patients had a seven-day mortality rate of 47%. (4) Conclusions and recommendations: The study found an unmet need for critical care services at our institution, as well as a need for tools to help clinicians make objective triage decisions for critically ill patients. Therefore, the study suggests a need to improve the quality of services provided outside of the ICU, particularly for patients who were refused ICU admission, to improve their outcomes.
- Full Text:
- Date Issued: 2023/06
- Authors: Ninise, Ezile Julie , Mrara, Busisiwe
- Date: 2023/06
- Subjects: ICU triage , Refusal rates , Nelson Mandela Academic Hospital , A retrospecive cross-sectional study
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/11260/13200 , vital:78090 , DOI: https://doi.org/10.3390/clinpract13040066
- Description: (1) Background: Patients who deserve intensive care unit (ICU) admission may be denied due to a lack of resources, complicating ICU triage decisions for intensive care unit (ICU) clinicians. Among the resources that may be unavailable are trained personnel and monitored beds. In South Africa, the distribution of healthcare resources is reflected in the availability of ICU beds, with more ICU beds available in more affluent areas. Data on ICU refusal rates, reasons for refusal, patient characteristics, and outcomes are scarce in resource-constrained rural settings. Hence, this study sheds light on the ICU refusal rates, reasons for refusal, characteristics, and outcomes of refused patients at NMAH. (2) Methods: This was a three-month retrospective cross-sectional record review of refused and admitted patients from January to March 2022. COVID-19 patients and those younger than 13 years old were excluded. Refusal rates, reasons for refusal, characteristics, and outcomes of refused patients were analysed quantitatively using SPSS VS 20 software. Reasons for refusal were categorised as “too well”, “too sick”, and “suitable for admission but no resources”. (3) Results: A total of 135 patients were discussed for ICU admission at NMAH during the study period; 73 (54.07%) were refused admission, and 62 (45.92%) were admitted. Being considered too sick to benefit from ICU was the most common reason for refusal (53.23%). Too well and no resources contributed 27.42% and 19.35%, respectively. Patients with poor functional status, comorbidities, medical diagnoses, and those referred from the ward or accident and emergency unit rather than the operating room were more likely to be refused ICU admission. Refused patients had a seven-day mortality rate of 47%. (4) Conclusions and recommendations: The study found an unmet need for critical care services at our institution, as well as a need for tools to help clinicians make objective triage decisions for critically ill patients. Therefore, the study suggests a need to improve the quality of services provided outside of the ICU, particularly for patients who were refused ICU admission, to improve their outcomes.
- Full Text:
- Date Issued: 2023/06
A review of the re-structuring of the Nelson Mandela Academic Hospital through the change management approach
- Authors: Nodikida, Mzulungile
- Date: 2018
- Subjects: Organizational change -- Case studies , Organizational change -- Management , Reengineering (Management) -- South Africa -- Mthatha , Leadership -- South Africa -- Mthatha , Organizational behavior -- South Africa -- Mthatha , Corporate culture -- South Africa -- Mthatha , Nelson Mandela Academic Hospital
- Language: English
- Type: text , Thesis , Masters , MBA
- Identifier: http://hdl.handle.net/10962/58339 , vital:27236
- Description: The research used a change management approach to analyze the restructuring of the Nelson Mandela Academic Hospital from a tertiary to a central hospital. The study was underpinned by two objectives. Firstly, to analyze the restructuring of the Nelson Mandela Academic Hospital from a tertiary to a "central" hospital using the Core Elements Framework of change management developed by Antwi and Kale (2014). Secondly, to use the knowledge gained through literature review combined with the experiences of the managers at Nelson Mandela Academic Hospital to inform future healthcare reforms in general and particularly in the restructuring of hospitals. The Core Elements Framework by Antwi and Kale (2014) identifies six fundamental change elements from both emergent and planned change management approaches. The six elements are regarded by theorists from the two different schools of thought i.e. emergent change and planned change as key for successful change. The Core Elements Framework by Antwi and Kale, (2014) demonstrates the strength of not viewing the two approaches to change management as mutually exclusive but as complementing each other when the other is falling short. The study identified the following: ■ The change was prompted by clearly identifiable external factors more than internal factors. ■ There was notable lack of organizational harmony which may have negatively impacted the change process. ■ The Private Public Partnership (PPP) funding model which was aimed at delivering the central hospital collapsed, after a study discovered that it benefited the private sector more than the public sector. ■ There was no proper consultation of major stakeholders for preparation of the change. ■ Resources in all material forms were not made available for the change to take off, this means that there was no organizational capacity to execute the change. The study draws the conclusion that lack of organizational capacity, organizational harmony and a proper consultation process for stakeholders are the main reasons why the restructuring of the Nelson Mandela Academic Hospital is not yielding the desired results. The study recommends that organizations should implement a multidimensional approach for any change initiative to be successful and that organizations must ensure the availability of the necessary resources when embarking on change.
- Full Text:
- Date Issued: 2018
- Authors: Nodikida, Mzulungile
- Date: 2018
- Subjects: Organizational change -- Case studies , Organizational change -- Management , Reengineering (Management) -- South Africa -- Mthatha , Leadership -- South Africa -- Mthatha , Organizational behavior -- South Africa -- Mthatha , Corporate culture -- South Africa -- Mthatha , Nelson Mandela Academic Hospital
- Language: English
- Type: text , Thesis , Masters , MBA
- Identifier: http://hdl.handle.net/10962/58339 , vital:27236
- Description: The research used a change management approach to analyze the restructuring of the Nelson Mandela Academic Hospital from a tertiary to a central hospital. The study was underpinned by two objectives. Firstly, to analyze the restructuring of the Nelson Mandela Academic Hospital from a tertiary to a "central" hospital using the Core Elements Framework of change management developed by Antwi and Kale (2014). Secondly, to use the knowledge gained through literature review combined with the experiences of the managers at Nelson Mandela Academic Hospital to inform future healthcare reforms in general and particularly in the restructuring of hospitals. The Core Elements Framework by Antwi and Kale (2014) identifies six fundamental change elements from both emergent and planned change management approaches. The six elements are regarded by theorists from the two different schools of thought i.e. emergent change and planned change as key for successful change. The Core Elements Framework by Antwi and Kale, (2014) demonstrates the strength of not viewing the two approaches to change management as mutually exclusive but as complementing each other when the other is falling short. The study identified the following: ■ The change was prompted by clearly identifiable external factors more than internal factors. ■ There was notable lack of organizational harmony which may have negatively impacted the change process. ■ The Private Public Partnership (PPP) funding model which was aimed at delivering the central hospital collapsed, after a study discovered that it benefited the private sector more than the public sector. ■ There was no proper consultation of major stakeholders for preparation of the change. ■ Resources in all material forms were not made available for the change to take off, this means that there was no organizational capacity to execute the change. The study draws the conclusion that lack of organizational capacity, organizational harmony and a proper consultation process for stakeholders are the main reasons why the restructuring of the Nelson Mandela Academic Hospital is not yielding the desired results. The study recommends that organizations should implement a multidimensional approach for any change initiative to be successful and that organizations must ensure the availability of the necessary resources when embarking on change.
- Full Text:
- Date Issued: 2018
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