Non-urgent patients in emergency centres in Western Cape district health services

Abstract

Background: Non-urgent patients are frequently found in emergency centres (ECs) and contribute to prolonged waiting times, overcrowding, high workloads and reduced quality of care. The aim of this study was to explore the perspectives of lead clinicians regarding patient attendance at ECs with non-urgent conditions in Western Cape district, South Africa.

Methods: An exploratory descriptive qualitative study in which semi-structured interviews with 19 family physicians and one emergency medicine specialist from 11 district hospitals and four community health centres were conducted.

Results: Key reasons for non-urgent patients to attend the EC were a lack of access to primary care, poor understanding of emergencies and health services, issues related to work and transport, referral by general practitioners, being seen quicker, preference for a doctor, dissatisfaction with primary care and worries about confidentiality. The effects were seen as reduced quality of care for urgent and non-urgent patients, overcrowding, reduced staff morale, many complaints as well as abusive behaviour, manipulation of the triage system, longer triage and waiting times.

Conclusion: Action should be taken to: strengthen the primary care platform through better access, coverage and quality of care; educate communities and general practitioners; harness digital technology and telehealth; change the way emergency medical services operate and ensure adequate staffing of ECs. Alternative methods for offering primary care should be evaluated.

Contribution: This article discusses the reasons for, effects of, and possible solutions to the problem of non-urgent patients attending ECs. Further studies may explore the perspectives of patients and medical officers.