In this article, we present a new methodology to model patient transitions and length of stay in the emergency department using a series of conditional Coxian phase‐type distributions, with covariates. We reformulate the Coxian models (standard Coxian, Coxian with multiple absorbing states, joint Coxian, and conditional Coxian) to take into account heterogeneity in patient characteristics such as arrival mode, time of admission, and age. The approach differs from previous research in that it reduces the computational time, and it allows the inclusion of patient covariate information directly into the model. The model is applied to emergency department data from University Hospital Limerick in Ireland, where we find broad agreement with a number of commonly used survival models (parametric Weibull and log‐normal regression models and the semiparametric Cox proportional hazards model).
Background
In East, Central and Southern Africa (ECSA), district hospitals (DH) are the main source of surgical care for 80% of the population. DHs in Africa must provide basic life-saving procedures, but the extent to which they can offer other general and emergency surgery is debated. Our paper contributes to this debate through analysis and discussion of regional surgical care providers' perspectives.
Methods
We conducted a survey at the College of Surgeons of East, Central and Southern Africa Conference in Kigali in December 2018. The survey presented the participants with 59 surgical and anaesthesia procedures and asked them if they thought the procedure should be done in a district level hospital in their region. We then measured the level of positive agreement (LPA) for each procedure and conducted sub-analysis by cadre and level of experience.
Results
We had 100 respondents of which 94 were from ECSA. Eighteen procedures had an LPA of 80% or above, among which appendicectomy (98%), caesarean section (97%) and spinal anaesthesia (97%). Twenty-one procedures had an LPA between 31 and 79%. The surgical procedures that fell in this category were a mix of obstetrics, general surgery and orthopaedics. Twenty procedures had an LPA below 30% among which paediatric anaesthesia and surgery.
Conclusion
Our study offers the perspectives of almost 100 surgical care providers from ECSA on which surgical and anaesthesia procedures should be provided in district hospitals. This might help in planning surgical care training and delivery in these hospitals.
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