Protocol for Exploring Effective Clinical Governance Strategies in South Africa’s Eastern Cape and Mpumalanga Provinces

Background: Hospitals are an integral part of the national health system. They provide a hub for health services that cannot be provided in the primary care setting, provide facilities for advanced investigation, diagnosis, and treatment, and constitute the platform for training and development of health professionals. However, when inspections were done at public sector facilities in preparation for the implementation of the NHI, the lowest average performance score was in leadership and corporate governance. This study aims to assess the effectiveness of clinical governance interventions in selected public hospitals in South Africa’s Eastern Cape and Mpumalanga provinces. Methods: This will be a cluster randomised study where there will be two intervention sites (a tertiary hospital and a regional hospital) and control sites (non-intervention central and regional hospitals). The intervention will comprise a focused implementation of clinical governance protocols (through training and coaching of hospital management and frontline health workers). There will be a pre-intervention baseline assessment; an assessment immediately at the end of the 12 months long intervention and an assessment at 36 months post-intervention. This builds on existing policy initiatives, quality improvement initiatives and tools. Information will be sourced through six sub-studies – three qualitative and three quantitative. Ethical clearance with reference number: 040/21 has been granted by the Research Ethics Committee of the Faculty of Health Sciences at Walter Sisulu University. Approvals to access the research sites with refence numbers: EC_202106_019 and MP_202106_009 have been granted by the Eastern Cape and Mpumalanga Provincial Health Research Committees respectively.Discussion: There is a need for a deeper understanding of how tertiary and regional hospitals operate, how these hospitals ensure provision of safe high-quality patient-centred clinical care and factors enabling them or hindering them from achieving higher performance. In addition, it is necessary to explore if the performance of the hospitals improves where there is a focused implementation of clinical governance protocols.

The contribution of family physicians in coordinating care and improving access at district hospitals: The False Bay experience, South Africa

This short report describes three family physicians (FP)-led clinical governance interventions to strengthen the care access and coordination in an urban district hospital in Cape Town, South Africa. The actual experiences and their effects on health services are captured here. The report also describes a range of interventions from enhanced access to timely computer tomographic scans to determine definitive care, to creating a local referral forum between levels of care, which resulted in a renewed appreciation for the scope of services and illness burden managed by the district health system and to the establishment of an onsite echocardiology service at the local district hospital to enhance the identified burden of disease of the local community. Each of these interventions were planned and implemented based on local data in partnership with the team members at the different levels of care. By applying an inclusive and distributed leadership style as informed by care access to scarce resources was better coordinated for the local communities served. The importance of the building trusting relationships between FPs and referral hospital colleagues cannot be overemphasised. Family physicians should be integrated and collaborated in the clinical governance platforms across levels of care. The FP’s roles as primary care consultant and clinical governance leader are pivotal in enhancing service delivery efficiency and in providing quality healthcare.

The basics

This chapter covers the basic knowledge required for good care of the woman. It explains the reproductive anatomy, the menstrual cycle, and the physiology of conception. It then describes history taking and physical examinations associated with women’s health, diagnostic tests, consent and confidentiality, and taking good records. General processes, including infection control, health and safety control of hazardous substances, adult safeguarding, disability, and domestic abuse are all covered. Finally risk management and clinical governance are explained.

SP10.2.13 Theatre-team meeting start times during the COVID-19 pandemic: An audit of elective orthopaedic theatre practices at a high volume elective orthopaedic centre during the COVID-19 pandemic

Aims The estimated cost of running an NHS theatre is 20 pounds per minute therefore it is essential that theatres runs as efficiently as possible to reduce waste. After elective services were restarted a disproportionate increase in late theatre start times was observed. An audit was carried out to evaluate whether team meetings were beginning on time (08:00) and if not; the length of and reason for the delay. These findings were presented at Clinical Governance and a re-audit was done to see if there had been any improvement. Method Data was recorded on an audit proforma in each theatre before the first case. This was done for 2 weeks over 12 days of theatre sessions and subsequently analysed to evaluate if practice was compliant with local theatre protocols. Results First cycle – average team brief start time of 08:05 with 17/18 (94%) of late starts due to surgeon/anaesthetist lateness. Second cycle - average team brief start time of 08:08 with 10/22 (45%) of late starts due to surgeon/anaesthetist lateness. Conclusions Late starts led to further delays to the patient being sent for and arriving in theatre; late starts were usually caused by doctors/surgeons. The proportion of late starts due to the surgeon/anaesthetist (45%) decreased compared to the first cycle (94%) suggesting that theatre team members successfully adapted their practices following changes to local protocols during the COVID-19 pandemic. A number of extraneous factors were also attributed to the later average start times in the second cycle.

1373 Semi-Elective Trauma Patients Pathway and Medical Clerking Proforma, Closed Loop Audit

Introduction Semi-elective Trauma care is a service provided by the Trauma and Orthopaedic department for patients who sustain fractures to the upper and lower limbs requiring surgical intervention, are still ambulatory and can be cared for safely at home until the date of operation. Aim To assess patients’ referral pathway and clerking documentation against the Standards for the Clinical Structure and Content of Patient Records, published by the RCSEng. Method We performed a closed loop audit on the clerking documentation and the referral pathway for these patients. We collected data retrospectively for three months, assessing the clerking documentation against the guidelines. The data was analysed and presented at our Clinical Governance meeting. We then implemented the Semi-Elective Trauma Pathway and the Medical Clerking Proforma. Afterwards, data was collected prospectively to complete the audit cycle. Results A sum of 181 patient were included. Before the use of our changes, only 36% of patients had a complete clerking documentation, with two cases of near misses, and no comprehensive referral pathway for these patients. Post implementation of the Pathway and the Clerking Proforma, 88% of patients had complete clerking documentation, no near misses and 95% of them went properly through the pathway we introduced. Conclusions These patients present an important part of any trauma list. This Audit shows that having a comprehensive referral pathway and a clerking proforma will make sure that patients will have full medical history taken and are ready for the operation on the day of surgery and decrease the number of near misses.