Abstract
BackgroundPrimary health care worldwide faces large numbers of patients daily. Poor waiting times, low patient satisfaction and staff burnout are some problems facing such facilities. Limited research has been done on sorting patients in non-emergency settings in Africa. This research looked at community health centres (CHCs) in Gauteng Province, South Africa where queues appear to be poorly managed and patients waiting for hours. This study explores the views of clinicians in CHCs across Gauteng on sorting systems in the non-emergency ambulatory setting.MethodsThe qualitative study design used one-to-one, in-depth interviews of purposively selected doctors. Interviews were conducted in English, with open-ended exploratory questions. Interviews were recorded, transcribed, anonymised and checked by interviewees later. Data collection and analysis stopped with information saturation. The co-author supervised and cross-checked the process. A thematic framework was developed by both authors, before final thematic coding of all transcripts was undertaken by the principal author. This analysis was based on the thematic framework approach.ResultsTwelve primary health care (PHC) doctors with experience in patient sorting, from health districts across Gauteng, were interviewed. Two themes were identified, two major themes, namely Systems Implemented and Innovative Suggestions, and Factors Affecting Triage. Systems Implemented included those using vital signs, sorting by specialties, and using the Integrated Management of Childhood Illnesses approach. Systems Implemented also included doctor - nurse triage, first come first serve, eyeball triage and sorting based on main complaint. Innovative Suggestions, such as triage room treatment and investigations, telephone triage, longer clinic hours and a booking system emerged. There were three Factors Affecting Triage: Management Factor, including general management issues, equipment, documentation, infrastructure, protocol, and uniformity; and Staff Factor, including general staffing issues education and teamwork; and Patient Factor.ConclusionDeveloping a functional triage protocol with innovative systems for Gauteng is important. Findings from this study can guide the development of a functional triage system in the primary health care non-emergency outpatient setting of Gauteng’s CHCs. The Emergency Triage, Assessment and Treatment (ETAT) tool, modified for adult and non-clinician use, could help this. However, addressing management, staff and patient factors must be integral.
Highlights
Primary health care worldwide faces large numbers of patients daily
The time involved in measuring the necessary parameters is lengthy and this may not be viable in a busy primary health care outpatient department [10]
Results of this study indicate that while many different sorting systems have been implemented across Gauteng’s community health centres (CHCs) in the non-emergency outpatient setting, none of these attempts reported by interviewees have been an outright success
Summary
Primary health care worldwide faces large numbers of patients daily. Low patient satisfaction and staff burnout are some problems facing such facilities. Limited research has been done on sorting patients in non-emergency settings in Africa. Primary health care facilities worldwide, face increasing numbers of patients daily. The South African Triage Score (SATS), validated for use in emergency departments, was rolled out and spread to six other subSaharan countries [6]. Interrater and intra-rater reliability had been proven for lowresource countries other than South Africa [7, 8]. These findings apply only to emergency departments settings. There are questions about the limited reproducibility of vital signs, as well as sorting systems that do not use vital signs [11, 12]
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