Sick health system puts top hospitals under pressure

Almost a third of patients who had surgery at one of the country’s top eight public hospitals should not have ended up there.

An analysis of almost 3‚000 sets of medical records over a year showed that 29% of patients in the surgical wards at Charlotte Maxeke Academic Hospital in Johannesburg should have been treated at regional hospitals‚ such as those in Edenvale and Tembisa.

“The public healthcare system is overburdened at all levels‚” medical students from the University of the Witwatersrand wrote in this month’s edition of the South African Medical Journal.

“Lack of resources results in upward referral owing to local constraints. The scarcity of skills‚ supervision and support dictates that doctors in district hospitals refer cases to tertiary centres.

“This is especially true in surgery‚ which requires systems to function adequately and simultaneously [theatre‚ anaesthetics‚ surgery].”

The students‚ who undertook the research after the introduction in April 2015 of an electronic discharge database developed in the Wits medical school‚ said treatment in district hospitals would be more cost-effective for many patients.

They gave examples of the kind of surgical injuries that should be treated at which facilities:

• Primary: A laceration needing stitches;
• Secondary: A healthy young man needing an appendectomy under general anaesthetic;
• Tertiary: A diabetic patient with renal problems requiring removal of the colon; and
• Quarternary: Surgery requiring organ transplant and oncology teams.

Charlotte Maxeke is one of eight national referral centres. Its four surgical wards‚ with a total of 92 beds‚ are divided into breast and endocrine‚ gastroenterology‚ vascular and trauma.