A Systematic Assessment of Service Delivery in Preliminary Care Unit at a State Hospital in Sri Lanka

Year 2021, Volume: 3 Issue: 1, 41 - 54, 10.05.2021

S.m.n.s.m. Mallawarachchi

https://doi.org/10.52675/jhesp.829379

Abstract

          Preliminary Care Unit is the Sri Lankan model of the emergency department in the state health facilities above the level of Base Hospitals in the country. Provision of prompt, quality, and comprehensive patient care without any unnecessary delay, minimizing unnecessary admissions to wards, and reducing the cost of patient management were the objectives of establishing such units. The current study aimed to systematically assess the process of service delivery in the Preliminary Care Unit of District General Hospital, Gampaha. The study was descriptive with both cross-sectional and retrospective components and was conducted in 2019. Study instruments and techniques included are key informant interviews, focus group discussions, the desk review of secondary data, and direct observation. Key informant interviews with the medical officer-in-charge and nursing sister in charge of the unit were conducted by the principal investigator. Two focus group discussions were conducted, with ten randomly selected medical officers and 8 nursing officers with a minimum one-year of work experience at the Preliminary Care Unit. Data gathered from the desk review of the secondary data from the admission book, Bed Head Tickets, and record of monthly statistics of the preliminary care unit using a checklist to ascertain the total number of admissions and their outcome in 2018. All admissions of a randomly selected week of 2018 were studied to assess the age and gender distribution and they were classified into two categories as medical and surgical, according to the admitting doctor’s notes. Direct observation was used to triangulate the data. The major deficiencies of the process of service delivery in the Preliminary Care Unit elicited at the key informant interviews and focus group discussions were overcrowding and excess waiting which were multifactorial in causation. Less organized process flow and inadequate resource availability led to overcrowding and excess waiting. 

Keywords

Preliminary Care Unit, Emergency Care, Overcrowding, Waiting, Service Delivery

Supporting Institution

Self-funded

Thanks

The authors acknowledge the administrative support extended by the Medical Superintendent, DGH, Gampaha.

References

• Abraham, J., Burton, S., Gordon, H. S. (2020). Moving patients from emergency department to medical intensive care unit: Tracing barriers and root contributors. International Journal of Medical Informatics, 133,104012.
• Central Intelligence Agency. (2020, April 6. People and society-Sri Lanka. The World Factbook. https://www.cia.gov/library/publications/the-world-factbook/geos/ce.html
• Delpachithra, C., Jayasinghe, S. (2001). Overcrowding and 'floor" patients in state hospitals: Institutions can make a difference. Ceylon Medical Journal, 46,58–60.
• Derlet, R. W., Richards, J. R. (2000). Overcrowding in the nation’s emergency departments: Complex causes and disturbing effects. Annals of Emergency Medicine, 35,63–68.
• Drummond, A. J. (2002). No room at the inn: Overcrowding in Ontario’s emergency departments. CJEM, 4,91–97.
• Edussuriya, D. H., Marambe, K. N., Abeyasinghe, N., Jayawickramarajah, P. T. (2012). Competencies expected from a medical officer in performing medico legal duties: The results of a Delphi study conducted among judicial medical officers in Sri Lanka. Sri Lanka Journal of Forensic Medicine, Science and Law, 3,6–14.
• Forster, A. J. (2003). The effect of hospital occupancy on emergency department length of stay and patient disposition. Academic Emergency Medicine, 10,127–133.
• Goonerathne, I. (2011). Challenges towards an optimum in scientific scrutiny of forensic investigations in Sri Lanka. Sri Lanka Journal of Forensic Medicine, Science and Law, 2,11–14.
• Hardin, E. (1996). Emergency medicine and the laboratory. Journal of the National Medical Association, 88,279–282.
• Hill, B. (2005). Optimization of interhospital transfer of patients to reduce emergency department overcrowding. Electronic Theses and Dissertations, 619.
• Kelen, G. D., Kraus, C. K., McCarthy, M. L., Bass, E., Hsu, E. B., Li, G., Scheulen, J. J., Shahan, J. B., Brill, J. D., Green, G. B. (2006). Inpatient disposition classification for the creation of hospital surge capacity: A multiphase study. The Lancet, 368,1984–1990.
• Lynn, S. G., Kellermann, A. L. (1991). Critical decision making: Managing the emergency department in an overcrowded hospital. Annals of Emergency Medicine, 20,287–292.
• Makama, J., Iribhogbe, P., Ameh, E. (2015). Overcrowding of accident and emergency units: Is it a growing concern in Nigeria? African Health Sciences, 15,457.
• Sri Lanka Ministry of Health (2020, April 6). Facilities offered at different categories of Medical Care Institutions. http://www.health.gov.lk/CMS/cmsmoh1/viewcircular.php?cno=01-18/2020&med=english
• Sri Lanka Ministry of Health (1995). Manual of management of Teaching, Provincial, Base and Special Hospitals. Sri Lanka: Colombo.
• Sri Lanka Ministry of Health (2012). General Circular No:01-02/2012 Establishment and Management of Preliminary Care Units in Government Hospitals. Sri Lanka: Colombo.
• Sri Lanka Ministry of Health (2016). Accident and emergency care policy of Sri Lanka. Sri Lanka: Colombo.
• Risser, D. T., Rice, M. M., Salisbury, M. L., Simon, R., Jay, G. D., Berns, S. D. (1999). The potential for improved teamwork to reduce medical errors in the emergency department. Annals of Emergency Medicine, 34,373–383
• Schull, M. J., Slaughter, P. M., Redelmeier, D. A. (2002). Urban emergency department overcrowding: Defining the problem and eliminating misconceptions. CJEM, 4,76–83
• Trudeau, M., Holmes, M., Bodie, K., Porter, G., Sullivan, V., Tarasuk, J., Trembley, J. (2010). Optimizing resource allocation and patient flow: Process analysis and reorganization in three chemotherapy outpatient clinics. Healthcare Quarterly, 13,48–55
• World Health Organization. (2017, April 6). Primary Health Care Systems (PRIMASYS)-Case study from Sri Lanka. https://www.who.int/alliance-hpsr/projects/alliancehpsr_srilankaabridgedprimasys.pdf?ua=1