Browsing by Author "Bruijns, Stevan"

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    Describing suspected non ST-elevation acute coronary syndrome using troponin at a regional, public South African emergency centre with the Roche cardiac reader
    (South African Heart Association, 2018) Kabongo, Diulu; Kalla, Moosa; Allgaier, Rachel; Bruijns, Stevan
    Background: There are few data available regarding acute coronary syndrome presenting to emergency centres in sub-Saharan Africa compared to the rest of the world. The aim of this study was to describe the acute coronary syndrome diagnosis and its outcome in an undifferentiated chest pain population when using a troponin assay that predates current reference standards at a public, Cape Town emergency centre. Methods: A retrospective, cross-sectional design was used. Comparisons were made between the diagnosis, outcome and troponin result (using the Roche cardiac reader). Findings were descriptively presented. Troponin results were qualitatively described in relation to a non ST-elevation acute coronary syndrome diagnosis. Associations were tested using the Chi2-test. Results: Nine hundred and sixty-nine patients were included in the study, of which 40 patients (4%) were excluded due to poor clinical record keeping. Acute coronary syndrome was diagnosed in 256 patients (28%), from which 54 (21%) were troponin positive which differed to troponin negative acute coronary syndrome (p <0.001). Unstable angina was diagnosed in 197 (77%) of acute coronary syndrome patients. Conclusions: Unsurprisingly, a high proportion of chest pain patients did not have acute coronary syndrome. Unstable angina numbers were much higher than described elsewhere. Although it is not possible to relate this finding to the assay’s lower accuracy using only a descriptive design, a higher sensitivity assay would likely benefit the diagnostic process as it does elsewhere. Further research is required to explore safe, local diagnostic strategies that can strike a balance between patient safety and cost effectiveness.
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    Describing the categories of people that contribute to an Emergency Centre crowd at Khayelitsha hospital, Western Cape, South Africa
    (Elsevier, 2017-06) Ahiable, Emmanuel; Lahri, Sa ad; Bruijns, Stevan
    Introduction: Emergency Centre (EC) crowding has globally been recognised to adversely affect patients, staff and visitors. Anecdotally, local ECs are perceived to be fairly crowded, however, not much is known about the size of this crowd and what constitutes it. Although more reliable, resource restrictions render more detailed flow studies less achievable. This study describes the EC crowd at Khayelitsha hospital in Cape Town, South Africa as the number and different categories of people, at predefined times during the day over a four-week period. Methods: A prospective, cross-sectional design was used. Headcounts were made by predefined groups at 09h00, 14h00, and 21h00 every day for four weeks. Predefined groups included doctors, nurses, visitors, patients, and other allied health staff. Summary statistics were used to describe the data. Precision was described using the 95% confidence interval. Results: A total of 16,353 people were counted during the study period. On average, 6370 (39%) of the groups were staff, 5231 (32%) were patients and 4752 (29%) were visitors. Of the staff, 586 (3.6%) were EC doctors, 733 (4.4%) were non-EC doctors, 1488 (9%) were EC nurses, and 445 (3%) were non-EC nurses. Although patient numbers in the EC remained constant, visitors and non-EC staff varied significantly with visitors peaking in the afternoon and non-EC staff drastically reducing in the evening. The EC was consistently crowded – average occupancy: 130%. Conclusion: Staff levels fluctuated predictably, reducing at night and over weekends, while patient levels remained constant. Non-EC doctors more than doubled during the day on week shifts, in significantly more numbers thanEC doctors, suggesting thatmany of the patients in the ECwere likely to be admissions boarding in the EC. Visitor numbers were substantial during visiting hours and further aggravated crowding. Resourcelight studies involving flow are important to explore crowding in low- and middle income settings.