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

  • Grant Llewellyn Laing Greys Hospital
  • D L Skinner King Edward VIII Hospital
  • J L Bruce Greys Hospital
  • Coleen Aldous University of KwaZulu-Natal
  • V Govindasamy Greys Hospital
  • S R Thomson University of Cape Town
  • Damian L Clarke Greys Hospital
Keywords: Quality improvement, district hospitals

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.

Author Biographies

Grant Llewellyn Laing, Greys Hospital

MBChB, FCS(SA), Fellowship Trauma (SA), PhD
Pietermaritzburg Metropolitan
Department of Surgery
Greys Hospital
Pietermaritzburg

D L Skinner, King Edward VIII Hospital

MBChB, FCS(SA), MMed
Durban Department of Critical Care
King Edward VIII Hospital

J L Bruce, Greys Hospital

MBChB, FCS(SA)
Pietermaritzburg Metropolitan
Department of Surgery
Greys Hospital
Pietermaritzburg

Coleen Aldous, University of KwaZulu-Natal

PhD
Clinical School of Medicine
University of KwaZulu-Natal

V Govindasamy, Greys Hospital

MBChB, FCS(SA)
Pietermaritzburg Metropolitan
Department of Surgery
Greys Hospital
Pietermaritzburg

S R Thomson, University of Cape Town
MBChB, chM, FRCS (Edin & Eng)
Department of Gastroenterology
Groote Schuur Hospital
University of Cape Town
Damian L Clarke, Greys Hospital
MBChB, FCS(SA), MMedSci, MBA, MPhil, PhD
Pietermaritzburg Metropolitan
Department of Surgery
Greys Hospital
Pietermaritzburg
Published
2017-11-16
How to Cite
Laing, G., Skinner, D., Bruce, J., Aldous, C., Govindasamy, V., Thomson, S., & Clarke, D. (2017). Auditing surgical service provision at a South African tertiary institution: Implications for the development of district services. South African Journal of Surgery, 55(4), 31-35. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2048
Section
General Surgery