ABSTRACT
BACKGROUND: Globally there is increasing awareness of the need for end-of-life care and palliative care in hospitalised patients who are in their final year of life. Limited data are available on palliative care requirements in low- and middle-income countries, hindering the design and implementation of effective policies and health services for these patients. OBJECTIVES: To determine the proportion of patients who die within 1 year of their date of admission to public hospitals in South Africa (SA), as a proxy for palliative care need in SA. METHODS: This was a retrospective cohort study using record linkage of admission and mortality data. The setting was 46 acute-care public hospitals in Western Cape Province, SA. RESULTS: Of 10 761 patients (median (interquartile range (IQR)) age 44 (31 - 60) years) admitted to the 46 hospitals over a 2-week period in March 2012, 1 570 (14.6%) died within 1 year, the majority within the first 3 months. Mortality rose steeply with age. The median (IQR) age of death was 57.5 (45 - 70) years. A greater proportion of patients admitted to medical beds died within 1 year (21.3%) compared with those admitted to surgical beds (7.7%). CONCLUSIONS: Despite a median age <60 years at admission, a substantial percentage of patients admitted to public sector hospitals in SA are in the final year of their lives. This finding should be seen in the context of SA's high communicable and non-communicable disease burden and resource-limited public health system, and highlights the need for policy development, planning and implementation of end-of-life and palliative care strategies for hospitals and patients.
Subject(s)
Health Services Needs and Demand , Hospital Mortality , Hospitalization , Palliative Care , Adult , Age Factors , Aged , Female , Hospitals, Public , Humans , Male , Middle Aged , Retrospective Studies , South AfricaABSTRACT
The SARS-CoV-2 pandemic has challenged the provision of healthcare in ways that are unprecedented in our lifetime. Planning for the sheer numbers expected during the surge has required public hospitals to de-escalate all non-essential clinical services to focus on COVID-19. Western Cape Province was the initial epicentre of the COVID-19 epidemic in South Africa (SA), and the Cape Town metro was its hardest-hit geographical region. We describe how we constructed our COVID-19 hospital-wide clinical service at Groote Schuur Hospital, the University of Cape Town's tertiary-level teaching hospital. By describing the barriers and enablers, we hope to provide guidance rather than a blueprint for hospitals elsewhere in SA and in low-resource countries that face similar challenges now or during subsequent waves.
Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Hospitals, University/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Tertiary Care Centers/organization & administration , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Electronic Health Records/organization & administration , Emergency Service, Hospital/organization & administration , Humans , Intensive Care Units/organization & administration , Materials Management, Hospital , Pandemics , Patient Care Team , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Secondary Care Centers , South Africa/epidemiologyABSTRACT
The SARS-CoV-2 pandemic has presented clinicians with an enormous challenge in managing a respiratory virus that is not only capable of causing severe pneumonia and acute respiratory distress syndrome, but also multisystem disease. The extraordinary pace of clinical research, and particularly the surge in adaptive trials of new and repurposed treatments, have provided rapid answers to questions of whether such treatments work, and has resulted in corticosteroids taking centre stage in the management of hospitalised patients requiring oxygen support. Some treatment modalities, such as the role of anticoagulation to prevent and treat potential thromboembolic complications, remain controversial, as does the use of high-level oxygen support, outside of an intensive care unit setting. In this paper, we describe the clinical management of COVID-19 patients admitted to Groote Schuur Hospital, a major tertiary level hospital at the epicentre of South Africa's SARS-CoV-2 epidemic during its first 4 months.
Subject(s)
Coronavirus Infections/therapy , Hospitals, University/organization & administration , Pneumonia, Viral/therapy , Tertiary Care Centers/organization & administration , Adrenal Cortex Hormones/therapeutic use , Anticoagulants/therapeutic use , Antimicrobial Stewardship , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/psychology , Critical Care/organization & administration , Diabetes Complications , Humans , Intubation, Intratracheal , Medical Staff, Hospital/psychology , Oxygen Inhalation Therapy , Palliative Care , Pandemics , Patient Care Team , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/psychology , Respiration, Artificial , Risk Factors , SARS-CoV-2 , Social Support , South Africa/epidemiologyABSTRACT
The COVID-19 pandemic has placed significant strain on the oxygen delivery infrastructure of health facilities in resource-constrained health systems. In this case report, we describe a patient with severe COVID-19 pneumonia who was managed with high-flow nasal oxygen for 40 days, with an eventual successful outcome. We discuss the oxygen delivery infrastructure needed to offer this intervention, as well as the psychosocial impact on those undergoing treatment.