scholarly journals In-depth investigation of turn-around time of full blood count tests requested from a clinical haematology outpatient department in Cape Town, South Africa

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Leonard Mutema ◽  
Zivanai Chapanduka ◽  
Fungai Musaigwa ◽  
Nomusa Mashigo
Keyword(s):  
South Africa ◽  
Blood Count ◽  
Cape Town ◽  
Outpatient Department ◽  
Full Blood Count ◽  
Academic Hospital ◽  
Time Intervals ◽  
Laboratory Service ◽  
Retrospective Audit ◽  
Turn Around Time

Background: The performance of laboratories can be objectively assessed using the overall turn-around time (TAT). However, TAT is defined differently by the laboratory and clinicians; therefore, it is important to determine the contribution of all the different components making up the laboratory test cycle.Objective: We carried out a retrospective analysis of the TAT of full blood count tests requested from the haematology outpatient department at Tygerberg Academic Hospital in Cape Town, South Africa, with an aim to assess laboratory performance and to identify critical steps influencing TAT.Methods: A retrospective audit was carried out, focused on the full blood count tests from the haematology outpatient department within a period of 3 months between 01 February and 30 April 2018. Data was extracted from the National Health Laboratory Service laboratory information system. The time intervals of all the phases of the test cycle were determined and total TAT and within-laboratory (intra-lab) TAT were calculated.Results: A total of 1176 tests were analysed. The total TAT median was 275 (interquartile range [IQR] 200.0–1537.7) min with the most prolonged phase being from authorisation to review by clinicians (median 114 min; IQR: 37.0–1338.5 min). The median intra-lab TAT was 55 (IQR 40–81) min and 90% of the samples were processed in the laboratory within 134 min of registration.Conclusion: Our findings showed that the intra-lab TAT was within the set internal benchmark of 3 h. Operational phases that were independent of the laboratory processes contributed the most to total TAT.

scholarly journals Costs and process of in-patient tuberculosis management at a central academic hospital, Cape Town, South Africa

2012 ◽  
Vol 2 (3) ◽  
pp. 61-65 ◽  
Author(s):  
J. Janson ◽  
F. Marais ◽  
S. Mehtar ◽  
R. M. P. M. Baltussen
Keyword(s):  
South Africa ◽  
Cape Town ◽  
Academic Hospital

scholarly journals Secondary Prevention of Fragility Fractures: Are We Following the Guidelines?

2006 ◽  
Vol 88 (5) ◽  
pp. 470-474 ◽  
Author(s):  
N Prasad ◽  
D Sunderamoorthy ◽  
J Martin ◽  
JM Murray
Keyword(s):  
Vitamin D ◽  
Secondary Prevention ◽  
Nurse Practitioners ◽  
Blood Count ◽  
Fragility Fractures ◽  
Full Blood Count ◽  
Junior Doctors ◽  
Dexa Scan ◽  
Femur Fractures ◽  
Retrospective Audit

INTRODUCTION The aim of this study was to determine whether orthopaedic surgeons follow the British Orthopaedic Association (BOA) guidelines for secondary prevention of fragility fractures. PATIENTS AND METHODS A retrospective audit was conducted on patients with neck of femur fractures treated in our hospital between October and November 2003. A re-audit was conducted during the period August to October 2004. RESULTS There were 27 patients in the initial study period. Twenty-six patients (96%)had full blood count measured with LFT and bone-profile measured in 18 patients (66%). Only nine patients (30%)had treatment for osteoporosis (calcium and vitamin D). Only one patient was referred for DEXA scan. Steps were taken in the form of creating better awareness among the junior doctors and nurse practitioners of the BOA guidelines. In patients above 80 years of age, it was decided to use abbreviated mental score above 7 as a clinical criteria for DEXA referral. A hospital protocol based on BOA guidelines was made. A re-audit was conducted during the period August to October 2004. There were 37 patients. All had their full blood count and renal profile checked (100%). The bone-profile was measured in 28 (75.7%) and LFT in 34 (91.9%)patients. Twenty-four patients (65%) received treatment in the form of calcium + vitamin D (20) and bisphosphonate (4). DEXA-scan referral was not indicated in 14 patients as 4 were already on bisphosphonates and for 10 patients their abbreviated mental score was less than 7. Among the remaining 23 patients, 9 patients (40%) were referred for DEXA scan. This improvement is statistically significant (P = 0.03, chi square test). DISCUSSION AND CONCLUSIONS The re-audit shows that, although there is an improvement in the situation, we are still below the standards of secondary prevention of fragility fractures with 60% of femoral fragility fracture patients not being referred for DEXA scan. A pathway lead by a fracture liaison nurse dedicated to osteoporotic fracture patients should improve the situation.

scholarly journals A retrospective audit of pain assessment and management post-caesarean section at New Somerset Hospital in Cape Town, South Africa

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Effraim F. Munsaka ◽  
Dominique Van Dyk ◽  
Romy Parker
Keyword(s):  
South Africa ◽  
Pain Management ◽  
Caesarean Section ◽  
Pain Assessment ◽  
Cape Town ◽  
Transversus Abdominis ◽  
Annual Number ◽  
Perioperative Pain ◽  
Retrospective Audit ◽  
Perioperative Pain Management

Background: The most common major surgical procedure performed worldwide is the caesarean section (CS). Effective pain management is a priority for women undergoing this procedure, to reduce the incidence of persistent pain (a risk factor for postpartum depression), as well as optimise maternal-neonatal bonding and the successful establishment of breastfeeding. Multimodal analgesia is the gold standard for post-CS analgesia. At present, no perioperative pain management protocols could be identified for the management of patients presenting for CS at regional hospitals in South Africa. This audit aimed to review the folders of patients who underwent CS, with particular reference to perioperative pain management guidelines for CS.Methods: A descriptive, retrospective, cross-sectional audit was conducted. Three hundred folders (10% of the annual number of caesarean procedures performed) from New Somerset Hospital, a regional hospital in Cape Town, South Africa were reviewed.Results: The women were a mean age of 30 years (standard deviation [s.d.]: 6.2). Median gravidity was 3 (interquartile range [IQR]: 2–3) and parity was 1 (IQR: 1–2); 52% had previously undergone a CS. In 93.3% cases, spinal anaesthesia was employed for CS. Pain assessment was poor, with only 55 (18%) patients having their pain assessed on the day of the operation. Analgesia was prescribed in over 98% of the patients, however, medication was only administered as prescribed in 32.6%. Non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed in 5% of cases. None of the patients received a patient-controlled analgesia (PCA), transversus abdominis plane (TAP) block, or wound infusion catheter as supplementary strategies.Conclusion: Pain management for post-CS patient at this hospital is lacking. There is the need for the implementation of a structured assessment tool to improve administration of analgesics in these patients. In addition, the reasons for the omission of NSAIDs from the analgesia regimen requires investigation. Hospital requires post-CS pain protocols to guide management especially in resource-limited settings.

scholarly journals Implications of the introduction of laboratory demand management at primary care clinics in South Africa on laboratory expenditure

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Ozayr H. Mahomed ◽  
Ruth Lekalakala ◽  
Shaidah Asmall ◽  
Naseem Cassim
Keyword(s):  
South Africa ◽  
National Health ◽  
Laboratory Tests ◽  
Clinical Laboratory ◽  
Demand Management ◽  
Cost Savings ◽  
Full Blood Count ◽  
Potential Cost ◽  
Cross Sectional ◽  
Laboratory Service

Background: Diagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes.Objectives: This study aimed to analyse current laboratory expenditures at the primary healthcare (PHC) level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management.Methods: A retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL) to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software.Results: Approximately R35 million South African Rand (10%) of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment.Conclusions: Considerable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented.

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