BackgroundChest pain is a common clinical syndrome. However, there is a paucity of African studies describing the causes, prevalence, aetiology, and disposition of patients with chest pain presenting in the emergency department (ED).AimThe aim of this retrospective descriptive study was to determine the prevalence, causes, demographics, and disposition of all adult patients with the main complaint of chest pain presenting at the ED of a regional hospital in South Africa.MethodsRecords of all patients 18 years and older presenting with the complaint of chest pain from 1 December 2011 through 10 April 2012 were assessed. A data collection sheet capturing patient demographics and disposition from the ED was used. The diagnosis was subdivided into groups: cardiovascular, respiratory, gastrointestinal, musculoskeletal, psychiatric/psychogenic, other, and unknown.ResultsOf the 312 patients presenting with chest pain, 210 patient files were retrieved. The prevalence of non-traumatic chest pain was 1.66%. Respiratory disease was the most common cause (36.19%), with pneumonia the most common diagnosis (24.40%). Logistic regression showed diagnoses of acute cardiovascular disease or respiratory disease, older age, and transport by ambulance as being associated with admission.ConclusionThe main cause of acute chest pain was found to be respiratory disease, followed by musculoskeletal disorders. In the African context, the aetiology of acute chest pain differs from that in first world countries. Health workers should therefore pay special attention to respiratory conditions during diagnosis and management in African patients with acute chest pain.
Background: Tshwane District Hospital (TDH) is a level-one hospital, delivering services in the centre of Pretoria since February 2006. It is unique in location, being only 100 meters away from the tertiary hospital, Pretoria Academic Hospital (PAH). In South Africa, public sector emergency units are under enormous pressure with large patient numbers, understaffing and poor resources. TDH Emergency Department (ED) is a typical example. An average of 3 900 patients per month visited this ED in 2006. Recurrent complaints and dissatisfaction shown by the patients about prolonged waiting times before consulting the medical practitioners (MPs) in the ED were one of the initial challenges faced by the newly established hospital. It was decided to undertake quality improvement (QI) cycles to analyse and improve the situation, using waiting time as a measure of improvement.
Methods:A QI team was chosen to conduct two QI cycles. The allocated time for QI cycle 1 was from May to August 2006 and for QI cycle 2 from September to December 2006. A total of 150 waiting times of stable and unstable patients were evaluated. Fifty waiting times were recorded over a span of 24 hours for each data collection in May, September and December 2006. Waiting time was defined as the time from arrival of the patient in the unit until the start of the consultation by the MP. Surveys were done in May and September to analyse the problems causing prolonged waiting times. The implemented change included instituting a functional triage system, improvement of the process of up-and down-referrals to and from the tertiary hospital, easy access to stock, reorganisation of doctors' duty roster, reorganisation of the academic programme, announcement on waiting time to patients, nurses carrying out minor procedures and availability of reference books.
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