South African Public Health Research Articles

Managerial practices for app-based primary care telemedicine service acceptance in South Africa

Purpose: This study addresses the qualitative research phase of a mixed methods study conducted to investigate patient acceptance of an app-based telemedicine service for primary care aimed at South African public health care sector patients.Design/methodology/approach: Qualitative data were collected by means of semi-structured individual interviews with patients who had exposure to an existing app-based primary care telemedicine service in South Africa named Kena Health. Thematic analysis of the qualitative data using ATLAS.ti software was conducted to identify the relevant antecedents of telemedicine service acceptance in the study’s context.Findings/results: Eight antecedents of app-based primary care telemedicine service acceptance among South African patients (who are predominantly reliant on public health care sector services to receive medical care) were identified, namely, perceived compatibility, perceived ease of use, relative advantage, price value, trust, innovativeness, privacy perception and care perception.Practical implications: To date, prior literature has not yet identified the specific antecedents that would apply to the acceptance of an app-based telemedicine service for primary care among South African individuals who are predominantly reliant on the country’s public health care system to receive medical care.Originality/value: Our study contributes to the literature by identifying which existing factors of technology acceptance apply to primary care telemedicine service acceptance, predominantly in the South African public health care sector context. Furthermore, additional antecedents of telemedicine service acceptance that have not been included in technology acceptance theory until present, that is, (positive) privacy perception and care perception are identified.

Access to healthcare by undocumented Zimbabwean migrants in post-apartheid South Africa.

Zimbabwean undocumented migrants rely on the South African public health care system for treatment of non-communicable and communicable diseases, surgery and medical emergency services. A gap remains to understand undocumented migrant experiences at a time when accessing public healthcare has been topical in South Africa. This article aimed to describe and understand the experiences, challenges and health-seeking alternatives of undocumented Zimbabwean migrants in accessing healthcare services in Nellmapius in Pretoria. The study was conducted at Nellmapius in Pretoria. A qualitative descriptive research design was used. Structured interviews with 13 undocumented migrants were conducted by applying purposive and snowballing sampling techniques. The data were thematically analysed. Migrants reported that the attitudes by healthcare officials suggest unwillingness to provide services to undocumented migrants, aggravating their vulnerability and perennial illness. Migrants faced challenges of discrimination, a lack of professional service delivery, a lack of financial capacity to pay for services and a lack of documentation evoking health-seeking alternatives. Migrants continue to face challenges while accessing subsidised health care. This study confirms that medical xenophobia is generally present in the public health care centres, at least for the sampled undocumented Zimbabwean migrants. The majority of undocumented migrants cannot afford to pay for private healthcare.Contribution:The findings of this study inform national, provincial and local healthcare facilities to be ethical and provide dignified quality healthcare to undocumented migrants in line with international practices.

Healthcare transition practices of occupational therapists in South African public healthcare.

Healthcare transition (HCT), the process of transitioning an adolescent from paediatric- to adult-oriented care, is vital for improving the long-term health of adolescents with chronic conditions. The role of occupational therapy in HCT has not been well-researched. Effective HCT practices are necessary to ensure that adolescents have access to coordinated, optimal and uninterrupted occupational therapy services throughout this period of development. This study describes occupational therapists' self-perceived knowledge of HCT within the context of South African public health facilities, the HCT practices used, and the factors that promote or hinder the success of HCT within this context. The study utilised a quantitative, non-experimental and descriptive cross-sectional design. Simple convenience and snowball sampling were used to recruit participants via professional databases and social media forums. An online survey was used to collect data. Descriptive statistics and simple content analysis were used to analyse the information. This study identifies limitations in the knowledge and practical implementation of HCT within South African occupational therapy practice. Healthcare transition is characterised by inadequate use of policies, insufficient transition preparation and poor outcome measurements. There is a need for the development of training programmes and practice guidelines to optimise and support HCT implementation within South African occupational therapy practice. This study provides novel data on HCT practices utilised by occupational therapists in South African public health facilities. This study has potential use for the development of effective HCT programmes that can improve the functional outcomes of South African adolescents.

Conceptualizing a model for cloud-based hospital management systems for the South African public health sector

Background and Aim of Study: Real-time access of information in the healthcare environment is essential, as it not only helps medical personnel to have adequate and timely information, but it also assists patients to be served more easily. Hospitals in rural areas are operating at a low bandwidth and have poor IT infrastructure that causes intermittent networks leading to disruptions and slow service delivery. This necessitates the Hospital Management System (HMS) to be deployed in the cloud environment to reduce the challenges leading to poor service delivery. The aim of the study: to develop a model for cloud-based HMS for the South African public health sector. Material and Methods: This study identified three public district municipality hospitals in Gauteng Province, South Africa, that were already using HMS and used them for data collection. Each hospital had up to 50 healthcare workers, and this formed the population of 150 from the three hospitals, from which a sample size of 108 respondents was selected. Data were collected using a closed-ended questionnaire and analyzed quantitatively using SPSS v25. Results: The results demonstrated that the suggested model has a good prediction power of 60.9% (R2=0.609) and that with the exception of environmental aspects, the rest of the constructs has a significant contribution to the successful implementation of the cloud-based HMS. Social aspects had the highest prediction power of 60.0% (β=0.600) at p=0.001; followed by risk analysis and control with 41.3% (β=0.413) at p=0.009. On the other hand, environmental aspects had the least and non-significant prediction of 12.3%. Conclusions: This study contributes to the ongoing call to have seamless healthcare provision systems. The model developed in this study extends the research of modernizing healthcare provision by leveraging technological innovations.

A scoping review of prehabilitation interventions for arthroplasty patients.

Osteoarthritis (OA) is a long-term condition that causes significant impairment, and because of the increasing prevalence of OA, the demand for arthroplasty will continue to rise. However, the demand will not be matched by availability, because of prioritisation of trauma-related surgeries. Implementing prehabilitation could assist physiotherapists in having an impact on improving access by reducing the length of stay. The aim of our scoping review was to explore, map and identify trends and gaps to better inform the content of a prehabilitation programme. In our scoping review, studies between 1995 and 2020 were identified and included based on inclusion and exclusion criteria and study methodology described by Arksey and O'Malley. The results were collated and summarised as a narrative synthesis. A total of 200 articles were identified and exported from four databases of which 48 articles were included in the final analysis. Regarding the efficacy of prehabilitation interventions, 21 studies reported significant results supporting prehabilitation, whereas 11 studies reported non-significant results. Prehabilitation could be a valuable adjunct in reducing length of hospital stay and improving functional outcomes in adults undergoing total joint replacement. The scoping review described the information available on prehabilitation in lower limb arthroplasty patients and could potentially inform the design of a prehabilitation programme suitable for use in the South African public health context.

A cross-sectional study on factors influencing patient participation in undergraduate medical education in a public and private hospital in Johannesburg, South Africa

BackgroundThe active involvement of patients in medical education is a common practice globally. Despite this, there is a global paucity of data on patients’ views on their role in medical education. As such this study aimed to identify factors that influence patient participation in undergraduate medical education in public and private hospitals in Johannesburg.MethodsA cross-sectional study was conducted, using a 23-question, self-designed, paper questionnaire to collect data on patients’ perceptions of student involvement in their care – with regard to consent, confidentiality, ethics, and patient preferences. Participants were recruited on a voluntary basis in the Departments of Medicine, Surgery, and Gynaecology, at selected hospital sites. Fisher’s Exact and Chi-Square statistical tests were used where appropriate.ResultsTwo hundred and one adult patients, comprised of 150 public sector patients and 51 private sector patients, completed the questionnaire. One hundred and sixty-nine patients (84,1%) were willing to participate in undergraduate medical education and no notable difference between these sectors was demonstrated (p = 0,41). The results further demonstrated that the main factors influencing patient participation in undergraduate medical education across both sectors were (1) the presence of a supervising professional, (2) the perceived degree of invasiveness of a procedure, and (3) the perceived expertise of the student. In addition, data across other key themes such as consent, confidentiality, ethics, and patient preferences and perceptions were elucidated.ConclusionsThis study demonstrates that the majority of inpatients across the public and private sectors are willing to participate in undergraduate medical education to facilitate the development of healthcare professionals. It also demonstrated that most patients have a positive experience. However, more measures of quality informed consent need to be instituted to optimise the current role of the South African public health sector, whilst facilitating the development of a similar role for the South African private sector in future clinical education. In addition, further research is necessary to evaluate these findings in a South African context.

HIV Viral Load Testing in the South African Public Health Setting in the Context of Evolving ART Guidelines and Advances in Technology, 2013-2022.

HIV viral load (VL) testing plays a key role in the clinical management of HIV as a marker of adherence and antiretroviral efficacy. To date, national and international antiretroviral treatment recommendations have evolved to endorse routine VL testing. South Africa (SA) has recommended routine VL testing since 2004. Progressively, the centralised HIV VL program managed by its National Health Laboratory Service (NHLS) has undergone expansive growth. Retrospective de-identified VL data from 2013 to 2022 were evaluated to review program performance. Test volumes increased from 1,961,720 performed in 2013 to 45,334,864 in 2022. The median total in-laboratory turnaround time (TAT) ranged from 94 h (2015) to 51 h (2022). Implementation of two new assays improved median TATs in all laboratories. Samples of VL greater than 1000 copies/mL declined steadily. Despite initial increases, samples of fewer than 50 copies/mL stagnated at about 70% from 2019 and declined to 68% in 2022. Some variations between assays were observed. Overall, the SA VL program is successful. The scale of the VL program, the largest of its kind in the world by some margin, provides lessons for future public health programs dependent on laboratories for patient outcome and program performance monitoring.

Between suffering and coping: burnout in female medical doctors in South Africa.

Burnout is described as emotional and physical exhaustion, reduced accomplishment, together with an outlook of inadequacy and cynicism related to job stress. It has a harmful impact globally, especially in developing countries, such as South Africa. This study is a phenomenological collective case study focusing on burnout experience in a sample of female medical doctors working in a South African public hospital. Based on ongoing explorations of burnout themes, empirically based intervention strategies are needed to be developed and presented for the South African public health sector to prevent stress-related burnout. The findings support the trend in literature that burnout is an overwhelming experience for female medical doctors in South Africa. The study presents voices of female medical doctors, their concerns, the causes for burnout and their coping mechanisms. It provides a strong contribution to exploring and presenting women's experiences in working in the medical field in South Africa from a positive psychology perspective. The findings indicate the struggles and the coping mechanisms of female medical doctors working in the field.

Scoping review protocol of prehabilitation interventions for primary arthroplasty.

Osteoarthritis (OA) ranks fifth among all forms of disability worldwide and primary replacement arthroplasty is the treatment of choice in late-stage OA. The current situation in South Africa is that the waiting lists for arthroplasty are extensive with steep costs. According to many studies, physiotherapists can have an impact on this situation by implementing prehabilitation. The aim of our study is to identify the trends in the literature regarding the content of prehabilitation programmes as well as the gaps. The methodology will involve a literature search and the methodology as proposed by the Joanna Briggs Institute guidelines. The literature searches will be conducted in electronic databases and peer-reviewed journal studies will be included based on predetermined inclusion criteria. Two reviewers will screen all citations and full-text articles and the first author will abstract the data. The results will be organised into themes and sub-themes, summarised, and reported as a narrative synthesis. The proposed scoping review will map the breadth of knowledge available on the topic of prehabilitation in terms of exercise prescription principles, pre-operative optimisation and gaps. This scoping review is the first part of a study that aims to design a prehabilitation programme suitable for the South African public health user as the demographic and physical characteristics of its health users are unique and dependent on the context.

Governing Oneself Through HIV Diagnosis to Antiretrovirals.

The article focuses on the experience of reinventing oneself post HIV diagnosis when living on antiretrovirals. Six women and men enlisted for antiretrovirals in South African public health facilities were interviewed, and a qualitative analysis was conducted drawing on Foucault's theory of governmentality. For the participants, the prevailing governing rationality of taking personal responsibility for their health is synonymous with self-recovery and restoration of self-determination. From the hopelessness and despair of HIV diagnosis, for all six participants, committing to antiretrovirals enhances their capacity to take back control of their transformation from victim to survivor, and with it, a sense of personal integrity. Yet, an unwavering resolve to use ARVs is not always possible for some of them, is not preferable or is not always desirable, which perhaps signals that for certain people living with HIV, their life-long journey of self-governance with ARVs is likely to be characterized by constant contradictions.

Health Care Resource Utilization in Adults Living With Type 1 Diabetes Mellitus in the South African Public Health Sector: Protocol for a 1-Year Retrospective Analysis With a 5-, 10-, and 25-Year Projection.

Type 1 diabetes mellitus (T1DM) is less common than type 2 diabetes mellitus but is increasing in frequency in South Africa. It tends to affect younger individuals, and upon diagnosis, exogenous insulin is essential for survival. In South Africa, the health care system is divided into private and public health care systems. The private system is well resourced, whereas the public sector, which treats more than 80% of the population, has minimal resources. There are currently no studies in South Africa, and Africa at large, that have evaluated the immediate and long-term costs of managing people living with T1DM in the public sector. The primary objective was to quantify the cost of health care resource utilization over a 12-month period in patients with controlled and uncontrolled T1DM in the public health care sector. In addition, we will project costs for 5, 10, and 25 years and determine if there are cost differences in managing subsets of patients who achieve glycemic control (hemoglobin A1c [HbA1c] <7%) and those who do not. The study was performed in accordance with Good Epidemiological Practice. Ethical clearance and institutional permissions were acquired. Clinical data were collected from 2 tertiary hospitals in South Africa. Patients with T1DM, who provided written informed consent, and who satisfied the inclusion criteria were enrolled in the study. Data collection included demographic and clinical characteristics, acute and chronic complications, hospital admissions, and so on. We plan to perform a cost-effectiveness analysis to quantify the costs of health care utilization in the preceding 12 months. In addition, we will estimate projected costs over the next 10 years, assuming that study participants maintain their current HbA1c level. The cost-effectiveness analysis will be modeled using the IQVIA CORE Diabetes Model. The primary outcome measures are incremental quality-adjusted life years, incremental costs, incremental cost-effectiveness ratios, and incremental life years. Ethical clearance and institutional approval were obtained (reference number 200407). Enrollment began on February 9, 2021, and was completed on August 24, 2021, with 224 participants. A database lock was performed on October 29, 2021. The statistical analysis and clinical study report were completed in January 2022. At present, there are no data assessing the short- and long-term costs of managing patients with T1DM in the South African public sector. It is hoped that the findings of this study will help policy makers optimally use limited resources to reduce morbidity and mortality in people living with T1DM. RR1-10.2196/44308.

The Risk Implications of Ineffective Use of Human Resource Information Systems in the South African Public Health Sector

The Risk Implications of Ineffective Use of Human Resource Information Systems in the South African Public Health Sector

Cost utility and budget impact analysis of dexamethasone compared with bortezomib and lenalidomide for the treatment of second line multiple myeloma from a South African public health perspective

BackgroundMultiple myeloma is an incurable haematological malignancy that is associated with a high probability of relapse. The survival of relapsed patients has been greatly improved by the development of novel drugs such as lenalidomide and bortezomib. We assessed the cost-effectiveness of these drugs as second-line treatment for relapsed/refractory multiple myeloma (RRMM) patients in the South African public health care system.MethodsWe modelled 3 treatment strategies for second-line RRMM treatment: dexamethasone (standard of care), bortezomib (BORT) and lenalidomide plus dexamethasone (LEN/DEX) from the South African public health perspective. For each strategy we modelled a hypothetical cohort of relapsed/refractory multiple myeloma patients using a three-state Markov model over a 15-year time horizon. Efficacy and utilization data were obtained from the MM009/010 and APEX trials and external studies. Price and cost data were from local sources and presented in 2021 South African Rands. Outcomes were reported in quality adjusted life years (QALYs). Incremental cost effectiveness ratios (ICERs) were calculated for BORT and LEN/DEX and compared to a local cost-effectiveness threshold of R38 500 per DALY averted using the assumption that 1 DALY averted is equal to 1 QALY gained. A budget impact analysis was conducted to evaluate the financial impact of the introduction of BORT and LEN/DEX, respectively. Deterministic sensitivity analysis was undertaken to account for parameter uncertainties.ResultsThe modelled total costs of DEX, BORT and LEN/DEX were estimated to be R8 312, R234 996 and R1 135 323, respectively. DEX treatment provided 1.14 QALYs while BORT and LEN/DEX treatments provided 1.49 and 2.22 QALYs, respectively. The ICER of BORT versus DEX was R654 649 and that of LEN/DEX versus BORT was R1 225 542. Both BORT and LEN/DEX treatments were not cost-effective relative to a cost-effectiveness threshold of R38 500 per DALY averted. Both BORT and LEN/DEX significantly increase the 1 year budget-cost of RRMM treatment.ConclusionBoth BORT and LEN/DEX treatments are unlikely to be cost-effective strategies for second-line treatment of RRMM in South Africa. The results indicate that the drug prices of lenalidomide and bortezomib are key drivers of value for money. Price reductions could potentially make BORT more cost-effective.

HTA57 Recommendations for Evidence Generation Activities Supportive of National HTA in the South African Public Health Sector

HTA57 Recommendations for Evidence Generation Activities Supportive of National HTA in the South African Public Health Sector

Electronic Data Capture System (REDCap) for Health Care Research and Training in a Resource-Constrained Environment: Technology Adoption Case Study.

BackgroundElectronic data capture (EDC) in academic health care organizations provides an opportunity for the management, aggregation, and secondary use of research and clinical data. It is especially important in resource-constrained environments such as the South African public health care sector, where paper records are still the main form of clinical record keeping.ObjectiveThe aim of this study was to describe the strategies followed by the University of the Witwatersrand Faculty of Health Sciences (Wits FHS) during the period from 2013 to 2021 to overcome resistance to, and encourage the adoption of, the REDCap (Research Electronic Data Capture; Vanderbilt University) system by academic and clinical staff. REDCap has found wide use in varying domains, including clinical studies and research projects as well as administrative, financial, and human resource applications. Given REDCap’s global footprint in >5000 institutions worldwide and potential for future growth, the strategies followed by the Wits FHS to support users and encourage adoption may be of importance to others using the system, particularly in resource-constrained settings.MethodsThe strategies to support users and encourage adoption included top-down organizational support; secure and reliable application, hosting infrastructure, and systems administration; an enabling and accessible REDCap support team; regular hands-on training workshops covering REDCap project setup and data collection instrument design techniques; annual local symposia to promote networking and awareness of all the latest software features and best practices for using them; participation in REDCap Consortium activities; and regular and ongoing mentorship from members of the Vanderbilt University Medical Center.ResultsDuring the period from 2013 to 2021, the use of the REDCap EDC system by individuals at the Wits FHS increased, respectively, from 129 active user accounts to 3447 active user accounts. The number of REDCap projects increased from 149 in 2013 to 12,865 in 2021. REDCap at Wits also supported various publications and research outputs, including journal articles and postgraduate monographs. As of 2020, a total of 233 journal articles and 87 postgraduate monographs acknowledged the use of the Wits REDCap system.ConclusionsBy providing reliable infrastructure and accessible support resources, we were able to successfully implement and grow the REDCap EDC system at the Wits FHS and its associated academic medical centers. We believe that the increase in the use of REDCap was driven by offering a dependable, secure service with a strong end-user training and support model. This model may be applied by other academic and health care organizations in resource-constrained environments planning to implement EDC technology.

Is a hybrid of online and face-to-face services feasible for audiological rehabilitation post COVID-19? Findings from three public health patients.

BackgroundThe global coronavirus disease 2019 (COVID-19) pandemic has pushed many audiologists to incorporate remote service delivery methods to adhere to mandatory health and safety protocols. The use of tele-audiology for audiological rehabilitation may provide a sustainable, cost-effective modality to suit the existing need, particularly in low-resourced countries.ObjectivesThis study aimed to investigate the feasibility of implementing a hybrid tele-rehabilitation programme in a South African public health context. An online auditory training (AT) programme was used to determine (1) compliance, (2) clinical benefit, (3) participant experience and (4) costs.MethodA convergent mixed methods design with a feasibility approach was utilised. Data collection was done through questionnaires, in-booth assessments, online AT, and face-to-face interviewing. Participants undertook online AT over 4 weeks. For pre- and post-online AT, the Abbreviated Profile of Hearing Aid Benefit (APHAB), QuickSIN, entrance and exit questionnaires, interviews and a system usability scale were administered.ResultsKey findings of this study included (1) a high compliance rate (84.82%) with minimal clinician contact time at 3 h 25 min over 5–6-weeks; (2) improvement in perceived hearing aid (HA) benefit, and improvement in listening skills; (3) reported positive experiences; and (4) minimal programme costs at an average of R1350.00 per participant.ConclusionThe results showed positive indicators that the use of hybrid tele-rehabilitative strategies may provide a viable alternative to the traditional face-to-face modality. The hybrid approach showed clinical benefits, cost-effectiveness, minimal contact time as well as COVID-19 compliance. Further large-scale research is still needed.

Prognostic values of modifiable risk factors for cardiovascular events in South African health promotion.

BackgroundCardiovascular diseases (CVDs) are increasing at an alarming rate among the South African population. This study aimed to determine the prognostic value of modifiable CVD risk factors for fatal and non-fatal events to inform cardiovascular health promotion practices in the South African public health system.MethodsData was collected from individuals participating in the South African leg of a multi-national prospective cohort study. Binary logistic regression was applied to estimate odds of total, non-fatal and fatal cardiovascular events.ResultsBinary logistic regression analyses identified age as a predictor of non-fatal and fatal CV events, with ORs of 1.87 to 3.21, respectively. Hypertension increased the odd of suffering a non-fatal CV event by almost two and a half (OR = 2.47; 95% CI = 1.26, 4.85). Moreover, being physically active reduced the odd of non-fatal CVD events by 38% (OR = 0.62; 95% CI = 0.46, 0.83 for 1 Standard deviation increase of the weighted physical activity index score (WPA)). On the one hand, gamma-glutamyltransferase (GGT) was associated with a higher fatal cardiovascular disease risk OR = 2.45 (95% CI = 1.36, 4.42) for a standard deviation increase.ConclusionsElevated blood pressure, GGT, and physical activity have significant prognostic values for fatal or non-fatal CV events. These findings emphasise the importance of highlighting hypertension and physical activity when planning cardiovascular health education and intervention programmes for this population, with attention to the monitoring of GGT.

Quantifying the burden of the post-ICU syndrome in South Africa: A scoping review of evidence from the public health sector.

Background The post-ICU syndrome (PICS) comprises unexpected impairments in physical, cognitive, and mental health after intensive care unit (ICU) discharge, and is associated with a diminished health-related quality of life (HRQOL). A Cochrane review recommended more research in this field from low- and middle-income countries. Objectives This review aims to examine the extent and nature of publications in the field of PICS in the South African (SA) public health sector. Findings of available local research are contextualised through comparison with international data. Methods A comprehensive literature search strategy was employed. Inclusion criteria comprised publications enrolling adult patients following admission to SA public hospital ICUs, with the aim to study the main elements of PICS (ICU-acquired neuromuscular weakness, neurocognitive impairment, psychopathology and HRQOL). Results Three studies investigated physical impairment, 1 study psychopathology, and 2 studies HRQOL. Recommended assessment tools were utilised. High rates of attrition were reported. Neuromuscular weakness in shorter-stay patients had recovered at 3 months. Patients who were ventilated for ≥5 days were more likely to be impaired at 6 months. The study on psychopathology reported high morbidity. The HRQOL of survivors was diminished, particularly in patients ventilated for ≥5 days. Conclusion This review found a paucity of literature evaluating PICS in the SA public health sector. The findings mirror those from international studies. Knowledge gaps pertaining to PICS in medical, surgical and HIV-positive patients in SA are evident. No publications on neurocognitive impairment or the co-occurrence of PICS elements were identified. There is considerable scope for further research in this field in SA. Contributions of the study This review identified the available publications investigating the post ICU syndrome (PICS) in the South African public healthcare setting. A small number of ground-breaking studies were found. Knowledge gaps in this field were identified.

Combating antimicrobial resistance in neonatal infections: a South African perspective

The challenge of antimicrobial resistance in neonatal infections in low-income and middle-income countries requires attention. The Article by Rudzani C Mashau and colleagues in The Lancet Global Health provides insights into invasive neonatal infections, including antimicrobial resistance, within the South African public health sector.1 Of note, widespread antimicrobial resistance among neonates, at a population level, has been reconfirmed.

Triage and dysphagia: Are hospitals in the South African public health sector ready?

Dysphagia screening is unequivocally beneficial for individuals who may be at risk of swallowing impairment. Benefits range from capitalising on early intervention, facilitating hydration and nutrition, reduced financial costs for the patient and prevention of dysphagia-related complications. Why then is there a need for triage? Inefficiencies and often non-existence of screening and referral processes require one to consider if triage may be a more viable option in the public healthcare context. Dysphagia triage could potentially prioritise emergency swallowing care and identify patients who need immediate swallowing attention because of the nature or severity of dysphagia. The use of a dysphagia triage checklist could have implications for patient health outcomes in terms of the safety of oral diets, development of aspiration pneumonia, malnutrition, administration of oral medication and overall patient prognosis.