Emergency Centres Taking Strain in Western Cape

Emergencies are never scheduled.  In fact, they often come at the most inconvenient of times – especially during the Festive Season when roads are packed with motorists going on holiday when the province experiences a dramatic influx of people. This also brings a great number of road accidents that leaves families devastated.

The Emergency Centres (ECs) are the entry points into the public hospitals and therefore face the brunt of the pressure, when dealing with motor vehicle accidents and other trauma-related incidents. They are built to perform their core function, which is to render quick and efficient emergency medical care, and are staffed accordingly.

Western Cape Minister of Health, Dr Nomafrench Mbombo, says that the current pressures at Western Cape health facilities across the service platform, not only at hospitals and emergency centres, are real.

When less-than-urgent cases flood the ECs, it causes a reduction in efficiency of both the emergency service and the routine medical care provided. Simply because the facility is not built to deal optimally with non-emergency cases. Clients with non-urgent and non-life threatening injuries or illnesses can visit their local Primary Health Care (PHC) facility such as a 24 hour Community Health Centre (CHC) or clinic where they can be assisted much quicker, making more efficient use of the system.

One potential reason for clients not attending the PHC facilities could be the perception that using an EC facility results in faster turn-around-time for clients, when often the opposite is the case. While Western Cape Government Health ECs will not refuse medical care to anyone, it is important that the public be well informed in terms of efficient use of resources to ensure maximum efficiency.

Clients are urged to find out the details of their nearest health facility most appropriate for their needs. Minister Mbombo says, “Our facilities are overburdened and because of the triage system it is the clients with the non-life threatening state that end up waiting for long hours because the patient whose life is at risk, automatically gets treated immediately. Emergency Centres are for emergencies.”

The clients coming through the doors of the ECs are a reflection of the burden of disease within the larger population; which in itself is a function of upstream factors such as inter-personal violence, road traffic accidents, risk factors for chronic diseases such as smoking, alcohol abuse, lack of exercise and unhealthy diets, substance abuse, lack of proper housing and overcrowding. It is for this reason that the Western Cape Government's strategic objective to create a healthier society is a high priority.

There is always a tension between the escalating demand for services and the available resources. Shortage of beds is always relative to the demands on the service. To equip ECs to function optimally the Department has in the past few years systematically improved the infrastructure within ECs – New Somerset Hospital, Karl Bremer Hospital, Khayelitsha Hospital and the new Mitchells Plain Hospital are cases in point. Emergency medicine specialists have been permanently placed in emergency centres to strengthen clinical governance and quality of care.

The challenge is not shortages of medical equipment, but shortages of specialist doctors and nurses. This problem is not only in our province, but a world-wide problem, given the brain drain from developing countries to developed countries.

Western Cape Government Health does not have a single average waiting time for clients waiting for beds at a hospital, as this varies within a hospital at different times and between facilities. We are currently developing tools to measure this more systematically.

The department has embarked on numerous initiatives to address this matter including the following:

• upgrading the infrastructure and medical equipment of emergency centres
• a patient flow collaborative that has engaged with teams of staff working at Hospitals to address patient flow.