Health System- and Patient-Related Factors Associated with COVID-19 Mortality among Hospitalized Patients in Limpopo Province of South Africa’s Public Hospitals
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Setting, Design and Sampling
2.2. Data Collection
2.3. Data Analysis
2.4. Ethical Clearance and Permission to Conduct the Study
3. Results
“Insufficiently prepared emergency trolley resulted in not regularly giving treatment.”
“Difficulty in performing a procedure due to inability to access equipment”.
“No high flow oxygen machine while patients saturation dropping”
“Long turnaround time for laboratory results, or late receiving of PCR COVID-19 results.”
“Delay of the results from the laboratory”
“Delay from lab results”
“Poor monitoring by medical staff or monitoring was not done at all.”
“Inconsistent monitoring of vital signs.”
“Active resuscitation not performed.”
“Developed headache and later saturation deteriorated. Active resuscitation not done”.
“Patient needed intensive monitoring with a ventilator.”
“Patient presented with shortness of breath. The next level of care is when the patient deteriorates due to the lack of a ventilator in the ICU”.
“Late seeking of medical attention with severe respiratory distress.”
“Presented late with severe acute respiratory syndrome causing hypoxia.”
“The patient saturation deteriorated to 37% while receiving oxygen.”
“The patient was identified as critically ill with a 65–70% saturation on double Oxygen.”
“Severe COVID 19 pneumonia, the patient was oxygen-dependent with severe hypoxia.”
“Patient who died within 5 h presented with severe pneumonia—progressed rapidly.”
“Known asthmatic patient admitted with upper respiratory tract infection on treatment—condition deteriorated rapidly.”
“A 64 years old, known HIV on treatment, admitted with lower respiratory tract infection and condition rapidly deteriorated.”
“COVID-19 Pneumonia, RVD, stayed on the ward while on rebreathe oxygen”.
“93 y/o female, diabetes mellitus on treatment presented with persistent hypoglycemia and severe pneumonia. She demised within three days.”
“70 y/o female, Hpt & DM on Rx, presented with elevated HGT and severe pneumonia, she demised within 12 h.”
“69 year old, known with hypertension on treatment; admitted with congestive cardiac failure, diagnosed with COVID-19; condition deteriorated rapidly, and the patient demised.”
“70-year-old male known with hypertension, end-stage kidney disease, prostate cancer; admitted with a severe lower respiratory tract infection and uraemic encephalopathy.”
“Appropriate medication out of stock such as Anticoagulation therapy…”
“Relevant medication out of stock such as Anticoagulation, vitamin…”
“Other treatment out of stock (zinc)… Shortage of medication in the pharmacy.”
“No chest X-ray done, no vitamins.”
“Ordered stock not received on time.”
“Treatment ordered received late …led to poor management of patients in the unit.”
“Medical notes missing that led to an incomplete patient assessment record in the brown file.”
“Assessments done on the patient but nothing was written…capturing information was not accurate.”
“Poor monitoring of the patient, incomplete record of the patient’s assessment.”
“Staff shortage in the ward... Poor staffing of medical doctors.”
“Patient not seen by the doctor at the COVID-19 ward from the day of referral.”
“Shortage of staff contributed to inadequate medical care”.
“Inadequate support from the senior staff members.”
“Inadequate support from the staff.”
“Inadequate support from senior.”
“Standard treatment guideline in COVID -19 not adhered to.”
“Non-adherence to standard treatment guideline.”
4. Discussion
4.1. Sub-Standard Emergency Medical Care Provided
4.2. Referral System Inefficiencies Contributed to Delay in Access to Health Care Services
4.3. Advanced Age of Patients with Known and Unknown Comorbidities
4.4. Sub-Standard Management of COVID-19 Cases, Medical Records, and Resources
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- WHO. WHO Recommends Two New Drugs to Treat COVID-19. 2022. Available online: WHO.int (accessed on 10 April 2022).
- Okonji, E.M.; Okonji, O.C.; Mukumbang, F.C.; Van Wyk, B. Understanding varying COVID-19 mortality rates reported in Africa compared to Europe, Americas and Asia. Trop. Med. Int. Health 2021, 26, 716–719. [Google Scholar] [CrossRef] [PubMed]
- Obande, G.A.; Bagudo, A.I.; Mohamad, S.; Deris, Z.Z.; Harun, A.; Yean, C.Y.; Aziah, I.; Banga Singh, K.K. Current State of COVID-19 Pandemic in Africa: Lessons for Today and the Future. Int. J. Environ. Res. Public Health 2021, 18, 9968. [Google Scholar] [CrossRef] [PubMed]
- Report on Weekly Deaths in South Africa. 2022. South African Medical Research Council. Advancing Life. Available online: https://www.samrc.ac.za/reports/report-weekly-deaths-south-africa (accessed on 10 April 2022).
- Rose, N.; Pang, D.S.J. A practical guide to implementing clinical audit. Can. Vet. J. 2021, 62, 145–152. [Google Scholar]
- Young, P.; Hortis De Smith, V.; Chambi, M.C.; Finn, B.C. Florence Nightingale (1820–1910), 101 years after her death. Revista Médica de Chile 2011, 139, 807–813. [Google Scholar] [CrossRef] [PubMed]
- Tantrige, P.M. Clinical audits must improve to benefit patients, providers, and doctors. BMJ 2014, 349, g4534. [Google Scholar] [CrossRef]
- Hopks, J. Medical Error: The Third Leading Cause of Death in the US. BMJ 2016, 353, i2139. [Google Scholar]
- Collins, S. BMJ analysis calls Health system errors the third leading cause of death and shines new light on ongoing problems. Pharm. Today 2016, 22, 36–37. [Google Scholar] [CrossRef]
- Vaziri, S.; Fakouri, F.; Mirzaei, M.; Afsharian, M.; Azizi, M.; Arab-Zozani, M. Prevalence of Health system errors in Iran: A systematic review and meta-analysis. BMC Health Serv. Res. 2019, 19, 622. [Google Scholar] [CrossRef] [Green Version]
- Ahsani Estahbanati, E.; Doshmangir, L.; Najafi, B.; Sari, A.A.; Gordeev, V.S. Incidence rate and financial burden of Health system errors and policy interventions to address them: A multi-method study protocol. Health Serv. Outcomes Res. Methodol. 2021, 22, 244–252. [Google Scholar] [CrossRef]
- Oleribe, O.E.; Momoh, J.; Uzochukwu, B.S.; Mbofana, F.; Adebiyi, A.; Barbera, T.; Williams, R.; Robinson, S.D.T. Identifying Key Challenges Facing Healthcare Systems In Africa And Potential Solutions. Int. J. Gen. Med. 2019, 12, 395–403. [Google Scholar] [CrossRef] [Green Version]
- Almazrou, D.; Egunsola, O.; Ali, S.; Bagalb, A. Medication Misadventures Among COVID-19 Patients in Saudi Arabia. Cureus 2021, 13, e15513. [Google Scholar] [CrossRef] [PubMed]
- Xu, J.; Ma, X.-P.; Bai, L.; Wang, M.; Deng, W.; Ning, N. A systematic review of etiology, epidemiology, clinical manifestations, image findings, and medication of 2019 Corona Virus Disease-19 in Wuhan, China. Medicine 2020, 99, e22688. [Google Scholar] [CrossRef] [PubMed]
- Ava, M.; Ahmadvand, A.; Hadjibabaie, M.; Javadi, M.; Khoee, S.H.; Dastan, F.; Gholami, K. A review of medication errors in iran: Sources, underreporting reasons and preventive measures. Iran. J. Pharm. Res. IJPR 2014, 13, 3. [Google Scholar]
- Rodziewicz, T.L.; Houseman, B.; Hipskind, J.E. Medical Error Reduction and Prevention—StatPearls; National Department of Health: Pretoria, South Africa, 2021.
- Mauti, G.; Githae, M. Medical error reporting among physicians and nurses in Uganda. Afr. Health Sci. 1970, 19, 3107–3117. [Google Scholar] [CrossRef]
- Sears, K.; Beigi, P.; Niyyati, S.S.; Egan, R. Patient-related risk factors for the occurrence of patient-reported medication errors in one community pharmacy: A local perspective. J. Pharm. Technol. 2016, 32, 3–8. [Google Scholar] [CrossRef]
- Carver, N.; Gupta, V.; Hipskind, J.E. National Policy for Patient Safety Incident Reporting and Learning in the Public Health Sector of South Africa. In Medical Error—StatPearls; National Department of Health: Pretoria, South Africa, 2021. [Google Scholar]
- Aljaffary, A.; Al Yaqoub, F.; Al Madani, R.; Aldossary, H.; Alumran, A. Patient Safety Culture in a Teaching Hospital in Eastern Province of Saudi Arabia: Assessment and Opportunities for Improvement. Risk Manag. Health Policy 2021, 14, 3783–3795. [Google Scholar] [CrossRef]
- Mansour, R.; Ammar, K.; Al-Tabba, A.; Arawi, T.; Mansour, A.; Al-Hussaini, M. Disclosure of Health system errors: Physicians’ knowledge, attitudes and practices (KAP) in an oncology center. BMC Med. Ethics 2020, 21, 74. [Google Scholar] [CrossRef]
- Kalra, J.; Kalra, N.; Baniak, N. Medical error, disclosure and patient safety: A global view of quality care. Clin. Biochem. 2013, 46, 1161–1169. [Google Scholar] [CrossRef]
- Esposito, P.; Canton, A.D. Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology. World J. Nephrol. 2014, 3, 249–255. [Google Scholar] [CrossRef]
- Thomas, T.; Laher, A.E.; Mahomed, A.; Stacey, S.; Motara, F.; Mer, M. Challenges around COVID-19 at a tertiary-level healthcare facility in South Africa and strategies implemented for improvement. S. Afr. Med. J 2020, 110, 964–967. [Google Scholar]
- Molefe, R. Limpopo’s Health Department Faces Medical Negligence Claims in Excess of R14 Billion. Available online: https://www.news24.com/news24/southafrica/news/limpopos-health-department-faces-medical-negligence-claims-in-excess-of-r14-billion-20220216 (accessed on 10 April 2022).
- Matlala, S.F.; Tshitangano, T.G.; Setati, M.E.; Ramalivhana, N.J.; Mphekgwana, P.M. Determinants of the Limpopo Province of South Africa’s Response to COVID-19: A Mixed Methods Protocol to Analyze and Share Lessons Learned. Healthcare 2022, 10, 926. [Google Scholar] [CrossRef]
- Tshitangano, T.G.; Setati, M.E.; Mphekgwana, P.M.; Ramalivhana, N.J.; Matlala, S.F. Epidemiological Characteristics of COVID-19 Inpatient Deaths during the First and Second Waves in Limpopo Province, South Africa. J. Respir. 2022, 2, 111–122. [Google Scholar] [CrossRef]
- Vaismoradi, M.; Turunen, H.; Bondas, T. Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nurs. Health Sci. 2013, 15, 398–405. [Google Scholar] [CrossRef] [PubMed]
- O’Connor, Parsons, Lane & Noble. New Jersey Personal. 2022. Available online: https://lawnj.net/ (accessed on 3 May 2022).
- Rose, S.; Hartnett, J.; Pillai, S. Healthcare worker’s emotions, perceived stressors and coping mechanisms during the COVID-19 pandemic. PLoS ONE 2021, 16, e0254252. [Google Scholar] [CrossRef] [PubMed]
- Giusti, E.M.; Pedroli, E.; D’Aniello, G.E.; Badiale, C.S.; Pietrabissa, G.; Manna, C.; Badiale, M.S.; Riva, G.; Castelnuovo, G.; Molinari, E. The Psychological Impact of the COVID-19 Outbreak on Health Professionals: A Cross-Sectional Study. Front. Psychol. 2020, 11, 1684. [Google Scholar] [CrossRef]
- Muhrer, J.C. Risk of misdiagnosis and delayed diagnosis with COVID-19. Nurse Pract. 2021, 46, 44–49. [Google Scholar] [CrossRef]
- Binnicker, M.J. Challenges and Controversies to Testing for COVID-19. J. Clin. Microbiol. 2020, 58, e01695-20. [Google Scholar] [CrossRef]
- Cawcutt, K.A.; Starlin, R.; Rupp, M.E. Fighting fear in healthcare workers during the COVID-19 pandemic. Infect. Control Hosp. Epidemiol. 2020, 41, 1192–1193. [Google Scholar] [CrossRef]
- Ho, S.M.Y.; Kwong-Lo, R.S.Y.; Mak, C.W.Y.; Wong, J.S. Fear of Severe Acute Respiratory Syndrome (SARS) among Health Care Workers. J. Consult. Clin. Psychol. 2005, 73, 344–349. [Google Scholar] [CrossRef]
- George-Svahn, L.; Eriksson, L.E.; Wiklander, M.; Björling, G.; Svedhem, V.; Brännström, J. Barriers to HIV testing as reported by individuals newly diagnosed with HIV infection in Sweden. AIDS Care 2020, 33, 1286–1295. [Google Scholar] [CrossRef]
- Rzymski, P.; Nowicki, M. COVID-19-related prejudice toward Asian medical students: A consequence of SARS-CoV-2 fears in Poland. J. Infect. Public Health 2020, 13, 873–876. [Google Scholar] [CrossRef] [PubMed]
- Bradley, M.; Chahar, P. Burnout of healthcare providers during COVID-19. Clevel. Clin. J. Med. 2020, 89. [Google Scholar] [CrossRef] [PubMed]
- Naidoo, R.; Naidoo, K. Prioritising ‘already-scarce’ intensive care unit resources in the midst of COVID-19: A call for regional triage committees in South Africa. BMC Med. Ethics 2021, 22, 28. [Google Scholar] [CrossRef]
- McCabe, R.; Kont, M.D.; Schmit, N.; Whittaker, C.; Løchen, A.; Baguelin, M.; Knock, E.; Whittles, L.K.; Lees, J.; Brazeau, N.F.; et al. Modelling intensive care unit capacity under different epidemiological scenarios of the COVID-19 pandemic in three Western European countries. Int. J. Epidemiol. 2021, 50, 753–767. [Google Scholar] [CrossRef]
- Mphekgwana, P.M.; Sono-Setati, M.E.; Maluleke, A.F.; Matlala, S.F. Low Oxygen Saturation of COVID-19 in Patient Case Fatalities, Limpopo Province, South Africa. J. Respir. 2022, 2, 77–86. [Google Scholar] [CrossRef]
- Yang, X.; Liu, Y.; Liu, Y.; Yang, Q.; Wu, X.; Huang, X.; Liu, H.; Cai, W.; Ma, G. Medication therapy strategies for the coronavirus disease 2019 (COVID-19): Recent progress and challenges. Expert Rev. Clin. Pharmacol. 2020, 13, 957–975. [Google Scholar] [CrossRef]
- Levitan, D.; London, V.; McLaren, J.R.A.; Mann, B.J.D.; Cheng, K.; Silver, M.M.; Balhotra, K.S.; McCalla, S.; Loukeris, K. Histologic and Immunohistochemical Evaluation of 65 Placentas From Women With Polymerase Chain Reaction–Proven Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection. Arch. Pathol. Lab. Med. 2021, 145, 648–656. [Google Scholar] [CrossRef]
- Czeisler, M.É.; Marynak, K.; Clarke, K.E.; Salah, Z.; Shakya, I.; Thierry, J.M.; Ali, N.; McMillan, H.; Wiley, J.F.; Weaver, M.D.; et al. Delay or Avoidance of Medical Care Because of COVID-19–Related Concerns—United States, June 2020. Morb. Mortal. Wkly. Rep. 2020, 69, 1250–1257. [Google Scholar] [CrossRef]
- Özdemir, Ö.; Nezir Engin, M.M.; Yılmaz, E.A. COVID-19-Related Pneumonia in an Adolescent Patient with Allergic Asthma. Case Rep. Med. 2021, 2021, 6706218. [Google Scholar] [CrossRef]
- Brinton, T.; Howell, G.; Arshad, H.; Ejaz, A.; Alakhras, I. Clinical outcomes of patients with asthma with COVID-19 pneumonia. Chest 2020, 158, A340. [Google Scholar] [CrossRef]
- Dong, Y.; Mo, X.; Hu, Y.; Qi, X.; Jiang, F.; Jiang, Z.; Tong, S. Epidemiology of COVID-19 Among Children in China. Pediatrics 2020, 145, e20200702. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bhaskaran, K.; Rentsch, C.T.; MacKenna, B.; Schultze, A.; Mehrkar, A.; Bates, C.J.; Eggo, R.M.; E Morton, C.; Bacon, S.C.J.; Inglesby, P.; et al. HIV infection and COVID-19 death: A population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform. Lancet HIV 2020, 8, e24–e32. [Google Scholar] [CrossRef]
- Kumar, S.; Nyodu, R.; Maurya, V.K.; Saxena, S.K. Morphology, Genome Organization, Replication, and Pathogenesis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In Coronavirus Disease 2019 (COVID-19): Epidemiology, Pathogenesis, Diagnosis, and Therapeutics; Springer: Singapore, 2020; pp. 23–31. [Google Scholar] [CrossRef]
- Ejaz, H.; Alsrhani, A.; Zafar, A.; Javed, H.; Junaid, K.; Abdalla, A.E.; Abosalif, K.O.; Ahmed, Z.; Younas, S. COVID-19 and comorbidities: Deleterious impact on infected patients. J. Infect. Public Health 2020, 13, 1833–1839. [Google Scholar] [CrossRef] [PubMed]
- Deborah, J.W.; Irl, B.H.; Jean, E.M. COVID-19: Issues Related to Diabetes Mellitus in Adults. Vietnam. J. Diabetes Endocrinol. 2021, 48, 75–84. Available online: https://vjde.vn/journal/article/view/272 (accessed on 10 May 2022).
- Guo, Y.-R.; Cao, Q.-D.; Hong, Z.-S.; Tan, Y.-Y.; Chen, S.-D.; Jin, H.-J.; Tan, K.-S.; Wang, D.-Y.; Yan, Y. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak—An update on the status. Mil. Med. Res. 2020, 7, 11. [Google Scholar] [CrossRef] [Green Version]
- Bode, B.; Garrett, V.; Messler, J.; McFarland, R.; Crowe, J.; Booth, R.; Klonoff, D.C. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. J. Diabetes Sci. Technol. 2020, 14, 813–821. [Google Scholar] [CrossRef]
- Targher, G.; Mantovani, A.; Byrne, C.D.; Wang, X.-B.; Yan, H.-D.; Sun, Q.-F.; Pan, K.-H.; Zheng, K.I.; Chen, Y.-P.; Eslam, M.; et al. Risk of severe illness from COVID-19 in patients with metabolic dysfunction-associated fatty liver disease and increased fibrosis scores. Gut 2020, 69, 1545–1547. [Google Scholar] [CrossRef]
- Elezkurtaj, S.; Greuel, S.; Ihlow, J.; Michaelis, E.G.; Bischoff, P.; Kunze, C.A.; Sinn, B.V.; Gerhold, M.; Hauptmann, K.; Ingold-Heppner, B.; et al. Causes of death and comorbidities in hospitalized patients with COVID-19. Sci. Rep. 2021, 11, 4263. [Google Scholar] [CrossRef]
- Tan, S.H.S.; Hong, C.C.; Saha, S.; Murphy, D.; Hui, J.H. Medications in COVID-19 patients: Summarizing the current literature from an orthopaedic perspective. Int. Orthop. 2020, 44, 1599–1603. [Google Scholar] [CrossRef]
- Hay, P.; Wilton, K.; Barker, J.; Mortley, J.; Cumerlato, M. The importance of clinical documentation improvement for Australian hospitals. Health Inf. Manag. J. 2019, 49, 69–73. [Google Scholar] [CrossRef]
- Mutshatshi, T.E.; Mothiba, T.M.; Mamogobo, P.M.; Mbombi, M.O. Record-keeping: Challenges experienced by nurses in selected public hospitals. Curationis 2018, 41, e1–e6. [Google Scholar] [CrossRef] [Green Version]
- Razu, S.R.; Yasmin, T.; Arif, T.B.; Islam, S.; Islam, S.M.S.; Gesesew, H.A.; Ward, P. Challenges Faced by Healthcare Professionals During the COVID-19 Pandemic: A Qualitative Inquiry From Bangladesh. Front. Public Health 2021, 9, 647315. [Google Scholar] [CrossRef] [PubMed]
- Magnavita, N.; Tripepi, G.; Di Prinzio, R.R. Symptoms in Health Care Workers during the COVID-19 Epidemic. A Cross-Sectional Survey. Int. J. Environ. Res. Public Health 2020, 17, 5218. [Google Scholar] [CrossRef] [PubMed]
- Magnavita, N.; Soave, P.M.; Antonelli, M. A One-Year Prospective Study of Work-Related Mental Health in the Intensivists of a COVID-19 Hub Hospital. Int. J. Environ. Res. Public Health 2021, 18, 9888. [Google Scholar] [CrossRef]
- Gavidia, M. How Has COVID-19 Affected Mental Health, Severity of Stress among Employees? 2020. Available online: https://www.ajmc.com/view/how-has-covid19-affected-mental-health-severity-of-stress-among-employees (accessed on 10 May 2022).
- Müller, F.; Tora, L. TBP2 is a general transcription factor specialized for female germ cells. J. Biol. 2009, 8, 97. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Designation | Role |
---|---|
Physician/family physician | Clinical audit leader |
Medical practitioner (COVID-19 ward) | Clinical notes audit |
Professional nurse(COVID-19 ward) | Clinical notes audit |
Operational manager(COVID-19 ward) | Clinical notes audit |
Quality assurance | Clinical notes audit |
Infection prevention and control (IPC) | Compilation of mortality line list |
Patient records | Patient record retrieval |
Health information | Capturing of data |
Data capturer | Capturing of data |
Themes | Sub-Themes (Frequency) |
|
|
|
|
|
|
|
|
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Sono-Setati, M.E.; Mphekgwana, P.M.; Mabila, L.N.; Mbombi, M.O.; Muthelo, L.; Matlala, S.F.; Tshitangano, T.G.; Ramalivhana, N.J. Health System- and Patient-Related Factors Associated with COVID-19 Mortality among Hospitalized Patients in Limpopo Province of South Africa’s Public Hospitals. Healthcare 2022, 10, 1338. https://doi.org/10.3390/healthcare10071338
Sono-Setati ME, Mphekgwana PM, Mabila LN, Mbombi MO, Muthelo L, Matlala SF, Tshitangano TG, Ramalivhana NJ. Health System- and Patient-Related Factors Associated with COVID-19 Mortality among Hospitalized Patients in Limpopo Province of South Africa’s Public Hospitals. Healthcare. 2022; 10(7):1338. https://doi.org/10.3390/healthcare10071338
Chicago/Turabian StyleSono-Setati, Musa E., Peter M. Mphekgwana, Linneth N. Mabila, Masenyani O. Mbombi, Livhuwani Muthelo, Sogo F. Matlala, Takalani G. Tshitangano, and Naledzani J. Ramalivhana. 2022. "Health System- and Patient-Related Factors Associated with COVID-19 Mortality among Hospitalized Patients in Limpopo Province of South Africa’s Public Hospitals" Healthcare 10, no. 7: 1338. https://doi.org/10.3390/healthcare10071338