Abstract
BackgroundNeonatal care is provided by various levels of healthcare facilities in South Africa. Intensive care for neonates is only provided at the higher levels, hence the need for transfers from lower-level to higher-level facilities (e.g. primary hospitals to tertiary hospitals) or across levels of facilities, particularly when life-threatening situations arise (e.g. cardiac deterioration, respiratory deterioration and desaturation).AimThe aim of the study was to explore neonatologists’ views regarding the neonatal transfer process and to describe the preparedness of advanced life support (ALS) paramedics to undertake such transfers.SettingThe setting consisted of neonatologists from three provinces i.e. KwaZulu-Natal, Gauteng and Western cape.MethodA qualitative descriptive design was utilised in this study. Semistructured interviews were conducted on the public health hospitals in three provinces (N = 9; n = 3) with neonatologists (N = 7; n = 7) who were involved in the transfers of critically ill neonates. The process of thematic analysis was used.ResultsThe themes that emerged in this study were: an awareness of local contextual realities related to neonatal transfers, challenges evident within the context of neonatal transfers, decision-making around the transfer of ill neonates, ALS paramedic preparedness for transfers and good clinical governanceConclusionThe study found that there was a need to be aware of local contextual realities confronting neonatal transfers, a need for greater preparedness for paramedics to undertake these transfers, a need for a sound referral processes and a need for coordinated transfer effort between paramedics, hospital staff and transport team members for the successful transfer of critically ill neonates.ContributionThe findings highlight the challenges confronting the neonatal transfer process in South Africa through the lens of neonatologist at public hospitals. Hence, the study reinforces the preparedness and coordination of the transfer process, along with more efficient communication between paramedics, hospital staff and the transfer team.
Highlights
A newborn infant, or neonate, is a child under 28 days of age, during which he or she is at the highest risk of dying (Negi et al 2019)
Strategies used were (1) member checking, (2) the triangulation of data, (3) maintaining an audit trail and (4) keeping a reflective journal
There were five themes that emerged in the data, namely an awareness of local contextual realities related to transfers (Theme 1), challenges evident within the context of neonatal transfers (Theme 2), decision making around the transfer of ill neonates (Theme 3), advanced life support (ALS) paramedic preparedness for transfers (Theme 4) and good clinical governance (Theme 5)
Summary
A newborn infant, or neonate, is a child under 28 days of age, during which he or she is at the highest risk of dying (Negi et al 2019). In sub-Saharan Africa, 1 in 36 children will die within the neonatal period (Masaba & Mmusi-Phetoe 2020). This is in comparison to high-income countries where the ratio is 1 in 333 (Ohunyan-Echichicya 2020). This emphasises the need to urgently consider how to reduce neonatal mortality rates in sub-Saharan Africa, as well as to reflect on the factors surrounding neonatal emergency care and transfers. As neonatal intensive care exists only at a few facilities, critically ill neonates are generally transferred to higher-level healthcare facilities. Intensive care for neonates is only provided at the higher levels, the need for transfers from lower-level to higher-level facilities (e.g. primary hospitals to tertiary hospitals) or across levels of facilities, when life-threatening situations arise (e.g. cardiac deterioration, respiratory deterioration and desaturation)
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