A Prospective Analysis Of The Impact Of Limited Space At The High DependencyUnit On Patient Outcomes In Emergency Care In Georgetown Public HospitalCorporation (Gphc) In Guyana
Introduction
Emergency care Departments globally, including at Georgetown Public
Hospital Corporation (GPHC) in Guyana, grapple with issues like overcrowding and
resource limitations.
Objectives
To evaluate the impact of limited space in the HDU on patient outcomes in
emergency care, identify factors contributing to space limitations, and provide
recommendations to improve patient care and outcomes despite spatial constraints.
Method
This prospective observational study included 116 patients admitted to the HDU
from the A&E Department and 60 medical personnel. Patient demographics, admission
details, bed availability, and outcomes were collected using a data collection tool developed
by the team. Challenges and staff suggestions were collected through an online survey.
Results
The mean age of patients was 48 years, with a female-to-male ratio of
approximately 1:1.2. Comorbidities were prevalent in 64.7% of patients, with hypertension
and Type 2 diabetes mellitus being the most common. Patients in the A&E (24.1%) and HDU
(12.1%) experienced complications, primarily respiratory failure. Outcomes included 62.1%
being discharged, 29.3% dying, 8.6% being stepped up, and 5.2% readmitted. The average ER
stay was 23 hours, and the average HDU stay was four days. Due to limited HDU space, 85.3%
of patients experienced delays in bed allocation. Survey responses indicated significant
concerns about inadequate HDU space, staffing, and patient flow management, and offered
actionable recommendations with emerging themes.
Conclusion
This study identified critical issues in emergency and high-dependency care
and the impact of limited HDU space. While many patients waited for HDU beds, no strong
significance was found between bed availability and outcomes. Survey responses revealed a
consensus on the need for enhanced HDU space, increased staffing, and better patient flow
management.
Recommendations
It is recommended to expand HDU capacity, increase staffing, enhance
patient flow management, upgrade infrastructure, provide ongoing staff training, establish
clear hospital policies, and implement quality improvement projects.
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