research report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management MAY 2014 / BACKGROUND: One of the key challenges facing the Limpopo Department of Health and Social Development in the area of Casualty Care is the lack of trained personnel and the inappropriate referral and utilisation of these services. There has been no known study conducted in this area in the South African context and therefore this study was undertaken to evaluate the services rendered within the Casualty Department at the Polokwane Mankweng Hospital Complex with specific reference to material and human resources as well as efficiency of the unit. AIM: To evaluate the Hospital Casualty Department in the Polokwane Mankweng Hospital Complex in terms of caseload, influencing factors and implications on resource utilisation during a one year study period. METHODOLOGY: A cross sectional study design was employed in this study. A retrospective record review was done and information was extracted from various sources of hospital information systems. No primary data was collected for this study. The setting of this study was the Casualty Departments at Polokwane Mankweng Hospital Complex. The two hospitals constituting this complex are situated 30 km apart in Polokwane and Turfloop respectively. Data was collected on various variables that are relevant to the functioning of, and resource utilisation in the Casualty Unit of this Complex. Variables including that of caseload, patient profiles, service costs and workload on human resources were measured. RESULTS: This study based on retrospective review of records of 250 patients’ records selected by a simple random sample from a cohort of 14,113 patients who attended the Casualty Department of the Polokwane Mankweng Hospital Complex during one year study period. One fifth of the patients were referred from other health facilities and more than 60% of the patients were discharged after receiving treatment which implied that these patients could be managed at a regional or district hospital. More patients with medical aid bypassed the referral system. Almost half of the patients arrived after-hours (from 18h00 to 6h00). This is the first study in the Limpopo Province which looked at the direct cost per patient at the Casualty Department. In 2008/09, overall expenditure was R 10,321,401.42 (including R 954,168.45 for pharmacy products, other consumables R 177,261.16 and Laboratory tests R 1,866,233.25). Overall the Department accounts for an estimated R 7,323,804 in personnel annual expenditure of the hospital. Unit personnel cost per patient was estimated at R518.94 (70.96% of total recurrent cost), while the unit costs for the Pharmaceuticals, Stores and Laboratory tests were; R67.23 (9.24%), R12.56 (1.72%) and R132.24 (18.08%) per patient respectively. Overall the combined unit cost was estimated at R731.34 per single emergency care patient excluding the capital costs. CONCLUSION: The results of the study will be used to guide the allocation of appropriate resources, and to highlight the need to implement an effective referral system, which will assist in reducing the workload.

Student no 9500767A Masters Report - School of Therapeutics / The aim and objectives of this study were to explore, interpret and describe young children’s experiences of hospitalisation for cardiac surgery and to describe their parents’ opinions regarding significant changes in the children one month after discharge. A qualitative design, grounded in phenomenology was used. Semi-structured interviews were conducted with the children prior to discharge and with their parents one month later. The children’s interviews were augmented by drawings, which were used to keep the children focused and to highlight themes that were not identified from their verbal accounts of hospitalisation. The expertise of a clinical psychologist was sought for the analysis of the children’s drawings. The results of the analysis of the drawings supported the children’s verbal accounts of their experiences in hospital. Children’s interviews revealed that young children experience and cope with hospitalisation for cardiac surgery very differently. Parents’ presence, pain and boredom were dominant themes that emerged from the children’s interviews. Behavioural changes and emotional responses included withdrawal, tearfulness, disturbed sleep patterns, sadness, fear, anger and happiness. Parents’ interviews one month after discharge revealed a lack of communication between the nurses and the children. iv It is recommended that further research be conducted with older children to determine the effects of stringent visitation regulations followed in the paediatric intensive care setting.

M.P.H., Faculty of health Sciences, University of the Witwatersrand, 2011 / Background: The hospital as an organisation employs many people who may be at risk for Injuries on Duty (IOD). Although IOD occur across the hospital and impact on staff morale and quality of care, no formal study has been conducted within the public hospitals in South Africa on the profile of employees who have sustained these injuries. This study was aimed at comprehensively describing the IOD and related factors at Klerksdorp/Tshepong/Potchefstroom (K/T/P) Hospital Complex in order to better understand and plan appropriate preventive strategies. Methodology: The study was based on a cross-sectional design involving retrospective record review obtained from the hospital information system. No primary data was collected. The study setting was K/T/P Hospital complex. All records of employees who sustained IOD during the study period were reviewed. Data was collected on relevant variables such as employee profile, type of IOD during the study period. Descriptive statistics was used to analyse the data. Results: The study found that the total number of IOD during this period was 152. The annual prevalence rate was 2.3% (Klerksdorp-Tshepong Hospital Complex) and 2.8% (Potchefstroom Hospital). . The category of employees who experienced injuries were administration (5.3%), support (18.8%), medical (34.9%), nursing (36.2%), professional (4.6%). The types of the injuries sustained were cut (8.6%), fall (19.7%), minor injuries (9.2%), needle prick (49.3%), patient related (1.3%), splash (11.8%). With regard to PEP costs, Klerksdorp Hospital incurred the highest costs of R31 231 34, followed by Potchefstroom Hospital with R23 714 83 and Tshepong Hospital with R19 305 57 during the study period

Introduction Low back pain can be influenced by demographic, lifestyle and co-morbid factors. No studies have been done on the relationship between these factors and low back pain in hospital employees in South Africa. The aim of this study was to determine which of these factors was present and how they influenced low back pain in staff employed at a district hospital in South Africa. Methods The study used a self-administered questionnaire on staff employed at the hospital. Results Results indicated that the point prevalence for low back pain was 47%. Most of the employees were female nurses aged between 26 and 40 years with BMI values higher than normal. The majority of the employees participated in exercises although this was mainly for 1 to 2 times a week. Among the demographic factors, only female gender was associated with increased risk of low back pain (OR 1,67 CI 1,04 ; 2,69) while for the lifestyle factors, participation in group exercises was a protective factor against low back pain (OR 1,66 CI 1,02 ; 2,70). Perceived stress all the time increased the risk of low back pain (OR 3,47 CI 1,46 ; 8,23). None of the isolated co-morbid diseases were associated with the presence of low back pain. Conclusion The prevalence of low back pain among Tshwane district hospital employees is high. Female gender and a high level of perceived stress increase the risk of low back pain while participation in group exercise reduces the risk of low back pain.

A Thesis submitted to the faculty of Commerce, Law and Management, University of Witwatersrand, School of Governance in 50% fulfilment for the Master of Management in the field of Monitoring and Evaluation 9 May 2016 / The purpose of the study was to analyse the Supply Chain Management (SCM) approaches used in the Public Hospital Outpatients Pharmacy and compare the findings with successful supply chain practices from other industry sectors. The study of academic literature locates the unavailability of drugs in the public hospital pharmacies to the domino effect of the lack of governance and accountability in the public hospital. The data for the study was gathered from public and private hospitals in Gauteng, and large FMCG manufacturers and retailers. The study finds that the public sector adoption of SCM in the absence of a coherent technology and human resource support environment results in a lack of accountability and coherence across systems. The research study corroborated the view of academics and the interviewees that the unavailability of drugs in the public hospital is a multidimensional problem that has its roots in the lack of governance throughout the drug supply chain. It is a complex manifestation of policy, processes, practices, structure, people, communication and donor funding that contribute to the problem. Resolving the drug availability issues will require the ‘whole supply chain re-engineering’ with the added focus on developing the operational capability and capacity of the actors within the supply chain continuum. / MT2017

MPH (Hospital Management), Faculty of Health Sciences, University of the Witwatersrand

No description available.

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Burns can represent devastating injuries surgically, psychologically and socially. A multidisciplinary team approach to patient management is requisite to successful patient management. Burns education is currently under-represented in national undergraduate surgical curricula with a resultant graduating workforce with sub-optimal burns management knowledge. There is therefore a drive to improve burns education nationally. In order to develop burns teams to perform with skill and efficiency, it is important to develop and advance their technical and non-technical skills. Simulation has proven to be a powerful modality to augment surgical training. Recreating authentic clinical challenges is crucial in optimising simulation-based team training. The majority of such team-based simulation takes place in dedicated simulation facilities or centres which are static and can be costly. This thesis presents eight peer-reviewed publications that chronologically represent a thematic series of publications in simulation and surgical education with an ultimate focus on burns education. The theoretical framework explores simulation strategies in light of educational theory, culminating in the development of "The Burns Suite" (TBS); a novel modality to advance the delivery of interprofessional burns education. TBS represents a low-cost, high-fidelity, portable, immersive simulation environment. It facilitates the delivery of an interprofessional realistic burn resuscitation scenario based on "advanced trauma and life support" (ALTS) and "emergency management of severe burns" (EMSB) principles. Scenarios were refined utilising expert opinion through cognitive task analyses. Participants considered TBS experience authentic due to its high psychological and social fidelity. This thesis contributes to burns surgical education by providing a better understanding of educational theory underpinning successful simulation and facilitating its interprofessional delivery via TBS. This approach can facilitate the design of future simulation scenarios that provide unique educational experiences where team members can learn with and from other specialties and professions in a safe, controlled environment. Addressing economic and practical limitations of current immersive surgical simulation is important. The low-cost approach of TBS has major implications for surgical education as a whole, particularly given increasing financial austerity. This thesis proposes that alternative, complex, and challenging scenarios and/or procedures can be recreated within TBS, providing a diverse educational immersive simulation experience that can be extrapolated into other surgical specialities and interprofessional arenas.

Class of 2007 Abstract / Objectives: To describe the after-hours medication needs in rural hospital pharmacies which are closed during the night. Methods: Entries in a night medication log from a 60 bed rural Arizona hospital that closed for 12 hours at night were collected. Complete entries were assigned a night of the week, a month of the year, and a two hour time period. Data was collected from April 1, 2005 to March 30, 2006. Entries were sorted into groups, counted, and ranked. Groups were compared using student’s t-test. The top 200 drug products ranked by quantity was recorded for a trial of fit into a night formulary. Results: The night medication log contained 4986 complete entries accounting for 669 individual drug products. Non-pharmacy staff entered the pharmacy after-hours 2070 times and removed 10449 drug dosage units. No significant difference in night medication need was found between summer and winter month or weeknight and weekend night. Early night need was significantly different than late night need (p = 0.01). The top 200 drug products covered 83.3% of the medication quantity need of the hospital. Conclusions: The study found that a large percentage (83.3%) of the night medication need could be accessible from a 200 item night formulary. Seasonal and weekend differences were non-significant with only time of night differences being significant. These results could justify the extending of current hours or establishment of a night formulary to decrease entrances into the pharmacy when a pharmacist is not on duty.