A patient flow system for antenatal primary healthcare facilities in the Frances Baard District, Northern Cape Province - Valla, Anna (University of the Free State, 2016)
Long waiting times in primary healthcare (PHC) facilities is a major challenge for the National Department of Health. The aim of the study was therefore to develop a patient flow system which would reduce long waiting times for patients in antenatal PHC facilities in the Frances Baard District, Northern Cape Province. A quantitative, non-experimental design was used to collect data. A specifically compiled checklist was applied to audit 12 antenatal PHC facilities to identify aspects which should be included in a proposed patient flow system. Twenty-one (n=21) healthcare providers also participated in an “in-action” Delphi technique process to seek consensus with regard to the identified aspects. The consensus seeking target was ≥ 60%. Subsequently, a patient flow system was compiled, based on the “in-action” Delphi technique process. The results of the audit checklist were discussed according to the main headings in the checklist of which the first was the need for a patient flow system. The major challenges in this regard are determined by the fact that only 50% (n=6) of PHC facility assessed had any form of patient flow system or an appointment system in place. Eight of the facilities (66.6%) regularly experience bottlenecks at reception and in waiting areas, observation and consultation rooms, and toilets and at the pharmacy. Secondly, a lack of human resources was identified. Eleven healthcare facilities (91.6%) did not have queue marshals to direct healthcare users and organize patient flow. During the study, 11 of the healthcare facilities (91.6%) experienced a shortage of professional nurses to render PHC. Only three healthcare facilities (25%) had a pharmacist assistant to dispense medication and professional nurses fulfilled this role. In the last instance, physical resources were also a problem. Ten of the healthcare facilities (83.3%) did not have computers, printers or Internet access. Nine of the facilities (75%) did not have the minimum equipment required to render proper basic antenatal care services. None of the healthcare facilities had a separate change room additional to the antenatal consultation rooms (n=12 100%). vii The level of consensus with regard to the list of identified aspects to be included in patient flow system gained from the audit results was 67%. Although these respondents agreed on the required proposed aspects to be included, they were also given an opportunity to add additional aspects. The original list of aspects was extended by adding the additional aspects agreed upon. No consensus was reached in the ranking of the aspects in the proposed patient flow system (< 60%). Consensus was reached on 25 of final list of 27 aspects to be included in the patient flow system. As indicated, a final patient flow system was developed based on the research results. The following recommendations would require further consideration as well: All healthcare facilities need dedicated, trained queue marshals to direct and organized the varied healthcare users. If this is not possible, administrative personnel, nursing staff or volunteers must be trained to execute this task. More healthcare providers need to be scheduled during clinic peak times. Healthcare users need to be booked according to appointment dates and times, to prevent overcrowded facilities and bottlenecks in the morning. A separate changing room where the next patient can undress while the present patient is being attended to would be ideal to save time. Finally, all healthcare facilities should have the necessary equipment and material resources to render proper healthcare services. It is extremely time consuming to move between consultation rooms sharing equipment, and is frustrating for both the healthcare provider and the healthcare user. Each antenatal consultation room should have a telephone to arrange referrals immediately and to swiftly obtain laboratory results on which treatment can be selected.

Lang wagtye in primêre gesondheidsorgfasiliteite (PGS-) is ’n groot uitdaging vir die Nasionale Departement van Gesondheid. Die doel van hierdie navorsing was om ’n pasiëntvloei sisteem vir voorgeboorte PGS- fasiliteite in die Frances Baard Distrik, Noord Kaap Provinsie te skep, wat die lang wagtye sal verkort. ’n Kwantitatiewe, nie-ekperimentele ontwerp is gebruik om data te versamel. ’n Spesifieke kontroleerlys is vir die oudit van 12 voorgeboorte PGS-fasiliteite ontwerp om aspekte wat in die voorgestelde pasiëntvloei sisteem ingesluit moet word, te identifiseer. Een-en-twintig (n=21) gesondheidsorg verskaffers het ook aan ’n “in-aksie” Delphi tegniek proses deelgeneem met die doel om konsensus oor die identifiseerde aspekte te bereik. Die teiken vir konsensus bereik was op ≥ 60% gestel. ’n Pasiëntvloei sisteem, op gegrond die van die “in-aksie” Delphi tegniek resultate, is gevolglik saamgestel. Die resultate van die ouditkontroleerlys is volgens die hoof opskrifte van die lys bespreek, waarvan die eerste die behoefte aan ’n pasiëntvloei sisteem is. Die hoof uitdagings in hierdie verband is bepaal deur die feit dat slegs 50% van die evalueerde PGS-fasiliteite oor ’n pasiëntvloei sisteem of afspraakstelsel beskik. Agt van die fasiliteite (66.6%) ervaar gereeld bottelnek probleme by ontvangs, in wagareas, waarnemings- en konsultasie kamers, die toilette en by die apteek. Tweedens is ’n tekort aan menslike hulpbronne identifiseer. Elf van die van die PGS-fasiliteite (91.6%) het nie oor “queue marshals” beskik om aanwysings aan gesondheidsorgverbruikers te gee of pasiëntvloei te beheer nie. Gedurende die navorsing het 91.6% van die fasiliteite (n=11) ’n tekort aan geregistreerde verpleegkundiges ervaar om voorgeboorte behandeling te verskaf. Slegs drie PGS-fasiliteite het apteek assistente beskikbaar en derhalwe moet geregistreerde verpleegkundiges die medikasie dispenseer. Laastens was daar ook ’n tekort aan fisieke hulpmiddels by die fasiliteite waargeneem. Tien van die PGS-fasiliteite (83.3%) het nie oor rekenaars, drukkers of Internettoegang beskik nie. Vyf-en-sewentig persent van die fasiliteite (n=9) het ook nie die minimum toerusting gehad om deeglike basiese voorgeboorte sorg te verskaf nie. Geen van die fasiliteite het aparte pasiëntkleedkamers gehad buiten die antenatale konsultasiekamers nie (100%, n=12). Die vlak van konsensus na die oudit met betrekking tot die lys van identifiseerde aspekte wat in die pasiëntvloei sisteem ingesluit behoort te word was 67%. Alhoewel die respondente saamgestem het oor die voorgestelde aspekte wat ingesluit moet word, is hulle ook geleentheid gegee om addisionele aspekte by te voeg. Die addisionele aspekte waaroor saam gestem is, is by die oorspronklike lys van aspekte gevoeg. Hoewel konsensus nie bereik is oor die volgorde waarin hierdie aspekte in die voorgestelde pasiëntvloei sisteem moet verskyn nie, was konsensus wel bereik by 25 van die 27 aspekte wat in die finale pasiëntvloei sisteem ingesluit is. Soos aangedui, is ’n finale pasiëntvloei sisteem gegrond op die navorsingsresultate saamgestel. Die volgende aanbevelings verg verdere oorweging: Alle PGS-fasiliteite vereis toegewyde, opgeleide “queue marshals” om die verskeie pasiënte te begelei en te organiseer, Indien dit nie moontlik is nie, moet administratiewe personeel, verpleegpersoneel of vrywilligers opgelei word om die taak te verrig. ’n Groter aantal gesondheidsorgpersoneel moet tydens piek kliniektye skeduleer word. Pasiënte moet volgens se afsprake datums en tye geskeduleer word om toestroming van kliniekfasiliteite en bottelnek probleme soggens te voorkom. Aparte kleedkamers waar die volgende pasiënt kan ontklee terwyl die huidige pasiënt aandag geniet is ideaal om tyd te bespaar. Laastens, moet alle PGS-fasiliteite oor die nodige toerusting beskik om effektiewe gesondheidsorg te verrig. Dit is uiters tydrowend om tussen konsultasie kamers te beweeg om toerusting te deel en kan tot frustrasie by beide die gesondheidsorgverskaffer en die -verbruiker lei. Elke konsultasie kamer behoort ’n telefoon te hê waarmee verwysings onmiddellik gedoen kan word en laboratoriumverslae spoedig bekom kan word om behandelingskeuses te vergemaklik.
Dissertation (M.Soc.Sc. (Nursing))--University of the Free State, 2016
Keywords: Patient flow system; Antenatal primary healthcare; “In-action” Delphi technique; Health care reform--South Africa--Northern Cape; Health care services--South Africa--Northern Cape