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Quantifying access block in a South African major trauma centre: a retrospective exploratory study
Nicholas George Chapman1, Ryoko Kinukawa1, Elchanan Reuven Nudelman1
1Trauma Directorate, Department of Surgery, Chris Hani Baragwanath Academic Hospital, Chris Hani Road, Diepkloof Zone 6, Soweto, Johannesburg, 1862, South Africa.
Summary
Access block, a delay in emergency department (ED) patient bed access, affected 61.3% of patients. Key factors included CT imaging, ICU admission, and mechanical ventilation, highlighting the need for system-wide solutions.
Area of Science:
- Emergency Medicine
- Health Services Research
- Trauma Surgery
Background:
- Access block, defined as delays in emergency department (ED) patients accessing inpatient beds, significantly contributes to ED overcrowding and adverse patient outcomes.
- This phenomenon is a critical issue in healthcare systems globally, impacting patient flow and resource allocation.
Purpose of the Study:
- To quantify the prevalence of access block within the Trauma Emergency Unit (TEU) at Chris Hani Baragwanath Academic Hospital.
- To identify demographic and clinical factors associated with access block in trauma patients.
Main Methods:
- A retrospective review of consecutive patients presenting to the TEU resuscitation room between January 1 and December 31, 2022.
- Exclusion criteria included patients under 14 years (or under 10 for burns) and those managed by other services.
- Access block was defined as a delay exceeding 8 hours; univariable analyses identified associated factors.
Main Results:
- Access block affected 61.3% of the 2091 patients with recorded length-of-stay.
- Factors significantly associated with access block included CT imaging (OR 4.17), intensive care unit (ICU) admission (OR 3.69), and mechanical ventilation (OR 2.10).
- Conversely, penetrating trauma and burns were associated with lower odds of access block (OR 0.61 and 0.50, respectively).
Conclusions:
- The high prevalence of access block underscores a significant system-wide challenge within the TEU.
- CT imaging, ICU admission, mechanical ventilation, and nighttime presentation are key factors contributing to access block.
- Addressing access block requires comprehensive, whole-of-system solutions, aligning with international consensus.