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KHAYELITSHA HOSPITAL PRESENTATION TO STANDING COMMITTEE ON COMMUNITY DEVELOPMENT Western Cape Government 2012 | Outline of presentation Population served by the Hospital Burden of Disease Clinical services and outcomes Improvement plan Western Cape Government 2012 | Population served by Khayelitsha Hospital Official population figures From Census 2011: Population: 391 749 Households: 118 809

Average household size: 3.3 62% of labour force (15-64y) employed 74% households monthly income < R3200. These numbers are hotly disputed in some circles. Western Cape Government 2012 | Age pyramid Burden of Disease Khayelitsha and its population are currently characterised by: A high proportion of households poor and dependant on public health services A heavy quadruple burden of disease communicable diseases (HIV and TB) non-communicable diseases (Diabetes / HPT / Mental Illness, etc.) diseases affecting pregnant women, newborns and children injuries (vehicle accidents, violence).

Western Cape Government 2012 | General information: Hospital catchment area and population Mfuleni CHC Nolungile CDC Town Two Clinic Site B / Khayelitsha CHC Matthew Goniwe Clinic Zakhele Clinic Luvuyo Clinic KuyasaClinic Mayenzeke Clinic

Michael Maphungwan a CHC Khayelitsha Hospital Western Cape Government 2012 | Services provided by Khayelitsha Hospital Hospital: Package of services Khayelitsha Hospital is a 340-bed hospital Opened in 2012 as a primarily District level facility. Due to pressures within the Community and limited capacity at the referral hospitals to absorb the patient load, the hospital has changed into a Large Metro District Hospital with a primarily Regional Package of Care. Other hospitals in this situation include Mitchells Plain Hospital, Karl Bremer Hospital and Victoria Hospital. It receives referrals from 7 City Health clinics and 4 MDHS health centres (1 shared) as well as NGOs and private health care providers. It refers patients primarily to Tygerberg Hospital (25km) and

Lentegeur Psychiatric Hospital (8.5km) Western Cape Government 2012 | Hospital: package of services offered Emergency Centre Forensics / Thuthuzela Unit Internal Medicine General Surgery and Orthopaedics Paediatrics and Neonatology Obstetrics and Gynaecology Mental Health Service Clinical Psychology

Radiology Services (X Ray, Ultrasound and CT Scan) Laboratory Services NHLS Western Cape Government 2012 | Outpatients Department Physiotherapy, Occupational Therapy Dietetics Speech Therapy, Audiology Social Services Khayelitsha Hospital: 340 BEDS Psychiatry 60

Obstetrics 58 Medicine 90 Paediatrics 32 Orthopaedics 14 Nursery 22 Surgery 31 Intermediate Care

30 Western Cape Government 2012 | Service trends, including pressure points Bed Occupancy Rate (%) 120 115 112 110 107 105 104 101 100 97 95 90

107 98 96 99 95 97 96 93 88 85 85 85 80 75 70 65

60 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Western Cape Government 2012 | Jul-18 Average Length of Stay : Incl/Excl Psychiatry 5.5 5.3 5.2 5.1 5.0 4.9 4.8 4.6 4.5 4.3

4.0 3.9 3.8 3.5 3.5 3.3 3.0 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 ALOS: without Psychiatry Western Cape Government 2012 | ALOS: with Psychiatry Jul-18 Emergency Centre and Outpatient Headcounts 4000 3883 3800

3600 3437 3400 3200 3069 3000 2905 2800 2600 2400 2200 2000 Apr-17May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Western Cape Government 2012 | EC OPD Patient Day Equivalents and Inpatient Days 14000

12470.33 12000 10153 10000 9050 8000 7617 PDE IPD 6000 4000 2000 0 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Western Cape Government 2012

| PDE vs other LMDH Western Cape Government 2012 | Hospital vs LDMH vs Provincial Mortality rates 3.2% 3.1% 3.0% 3.0% 3.1% 3.0% 2.9% 2.8% 2.7% 2.6% 2.5% 2.4% 2012-13

2.5% 2013-14 2014-15 KDH 2015-16 Large Metro Hospitals Western Cape Government 2012 | 2016-17 Province 2017-18 Hospital Service Pressures The following service components are under pressure due to the large volume of clients accessing the facility daily: Emergency Centre due to the high prevalence of violence and injuries. Internal Medicine Services, due to the high prevalence of

HIV and TB and Chronic Diseases Of Lifestyle. Neonatal service due to high Obstetric numbers (> 350 deliveries per month) with high rate of prematurity. Mental Health services, partially due to the high prevalence of substance abuse, as well as social pressures. Theatre Pressures due to expanding Surgical / Orthopaedic and Obstetric services Western Cape Government 2012 | Organisational aspects Hospital Management Ms. Grace Mashaba Acting CEO Mr Craig Olivier Dr Kitesh Moodley Ms Marie Voigt Acting DD:Nursing

Clinical Manager DD:Finance Western Cape Government 2012 | Vacant DD:Facilty Management Hospital Board Chairperson Mr. Z Feni Deputy Chairperson Mr. N Ndibongo Non-clinical Staff Ms E van Tonder

Clinical staff Dr. S Mukonkole Academic Interest Prof. D Helenberg Municipality(Councillor) Cllr. V Matanzima Community rep Ms P Mdini Community rep Mr A Nuko Community rep Mr N Tshengu

Community rep M L Mahomba Western Cape Government 2012 | Human Resource Matters Total of 617 posts funded at the hospital (15 August 2018) 46 posts currently vacant Shortages in specific areas (e.g Specialised nursing) reflect a National shortage Western Cape Government 2012 | New appointments and EE New Appointments :1 Jan -31 August 2018 Community Service Personnel Other Personnel 40 Total:

65 25 Race &Gender representivity at Khayelitsha District Hospital Race&Gender Total at Institution 297 93 42 76 15 29 10 9 African Female African Male Coloured Male Coloured Female White Male White Female

Indian Female Indian Male Total employees at institution Western Cape Government 2012 | 571 (%)Percentage at Institution 52% 16% 7% 13% 3% 5% 2% 2% Finance Budget 2017/18 R 330M Expenditure 2017/2018 R 350M Budget 2018 /2019 R373M

Western Cape Government 2012 | Challenges CHALLENGES Burden of disease within Khayelitsha has resulted in increased pressure on the public health facilities High incidence of TB / HIV Poorly controlled Chronic Diseases of Lifestyle High Obstetric numbers with complicated deliveries Interpersonal violence Substance abuse alcohol Fragmentation of the PHC services with Provincial and CoCT sites increases the challenges of gaining control of some of the above conditions Western Cape Government 2012 | CHALLENGES Khayelitsha Community has grown significantly over the past 6 years New informal settlements seen at the Spine roads / Endlovini and Baden Powell sites

In addition Mfuleni has been included in the drainage area of Khayelitsha hospital All of the above has resulted in increased service pressures with patient admissions beyond ward capacity Western Cape Government 2012 | Khaya 2013 Spine Road Baden Powell Endlovini Western Cape Government 2012 | 28 CHALLENGES High expectations and Increased scrutiny and pressure from political and societal organisations has resulted in high profile

media coverage, especially on social media This has lead to lowered morale of staff within the facility, with high turnover rates in some areas Western Cape Government 2012 | Additional interesting facts Paediatric Services Metro Paeds admissions 2017 KDH deaths 2017 : Total 29 7000 6000 Transport; Sepsis; 8.33% 4.17% 5000 Pneumonia; 37.50%

Gastro; 8.33% 4000 3000 Ill-defined; 41.67% 2000 1000 TBH WH KDH NSH MPH HH VH Paarl ERH Surge Season 2018 TBH PICU Jan-Jun 2018: Total 480 3000 KDH; 19.38% 2500 2000 1500 Other; 80.63%

1000 500 0 Western Cape Government 2012 | RXH TBH KDH Gastro VIC LRTI MPH KBH NSH Obstetrics Service outcomes

HIE rate Chart Title 9 8000 8 7000 7 6000 6 5000 5 4000 4

3000 3 2000 2 1000 0 2012 1 2013 2014 2015 2016 2017 0 2012

2013 2014 2015 2016 2017 Deaths 50 45 40 35 30 25 20 15 10 5 0 2012

Deaths (2012-2017), 151 Deaths 2013 2014 2015 2016 2017 Western Cape Government 2012 | <1kg >1kg Orthopaedic Services Referrals ( VULA) 300 280 260

240 220 200 180 160 140 120 100 OOPD 281 17 -17 -17 l-17 -17 -17 -17 -17 -17 -18 -18 -18 -18 -18 -18 rc an eb v y un Ju g p ct p ar Apr ay Jun J J A Ma O No De

F M Au Se M 700 650 600 550 500 450 400 350 300 250 200 547 432 Theatre Cases 100 92

90 80 72 70 60 50 Ap r17 M ay -1 Ju 7 n17 Ju l- 1 Au 7 g1 Se 7 p1 O 7 ct -1

7 N ov -1 D 7 ec -1 7 Ja n1 Fe 8 b1 M 8 ar -1 Ap 8 r18 M ay -1 8 Ju n18 40

Western Cape Government 2012 | EC Resuscitation area January to June 2018 : Total 3177 7.40% Trauma-related; 44.04% Paeds Medical; 55.96% Adults 92.60% 0.55% Other; 17.76% 4.16% 2.27% RIP; 7.76% 13.02% T/F ; 74.49% 6.51%

35.14% 15.29% 23.06% Western Cape Government 2012 | Stab wounds / lacerations MVA/PVA Assault GSW Dislocation / Fractures Blunt trauma Burns Other Crime Statistics Khayelithsa 800 700 600

500 Murder Sexual Assault Attempted murder Aggravated Assault 400 300 200 100 0 2012 2013 2014 Western Cape Government 2012 |

2015 2016 2017 Achievements ACHIEVEMENTS SERVICE DELIVERY Seen a total of 466000 patients seen since January 2012 Total of 1000+ compliments vs 100 complaints Hospital pharmacy received a gold medal award in 2012 for the best functioning pharmacy in the province. National 78% in 77% in 95% in Core Standards National DOH audit in 2012

Provincial DOH internal audit in 2013 Provincial DOH internal audit in 2017 100% score in MBFI accreditation Western Cape Government 2012 | ACHIEVEMENTS - ACADEMIC NURSING SANC Accreditation for Nurse Training Since 2012, 22 nurses have progressed from Enrolled nursing to Professional or Professional to Specialty Nursing Leadership training : 2 OPMs studying PGD in health management, nursing directorate initiatives. MEDICAL Specialist Training site for Emergency Medicine / Medicine / Obs / Paediatrics / Surgery / Orthopaedics Completed training 2 Paediatrics / 1 Obs Currently training 3 registrars in EM / 3 Paeds / 2 Obs / 1 Ortho / 3 Med 45 Diploma graduates Primary Emergency Care (DiPEC) / Child Health (DCH) / Anaesthetics (DA) / HIV Management Western Cape Government 2012 |

Improvement Plan Services On Site Blood Bank (In Planning) Mental Health Unit (In Design) Intermediate Care Beds (October 2018) Initiation of Eye services, with iImproved screening and treatment of Diabetic Retinopathy Glaucoma Retinopathy of Prematurity Breast Clinic Screening and earlier diagnosis of Breast Cancer EC congestion Implemented a Q-marshal : assist to guide and improve communication at triage Strengthen night nursing office: complaint management after hours Linkages to PHC / CBS Intermediate care Western Cape Government 2012 | Conclusion:

Khayelitsha district years ago. Hospital was commissioned 5 It was built to meet the health needs of a large community, comprising mainly poor people, mostly reliant on public health services. The Staff, Hospital management and the board are working within the prescripts of the package of care and financial envelope to meet the communitys health needs and DOH priorities. Western Cape Government 2012 | Better communication with surrounding community Local media features: volunteers and community healthcare workers Western Cape Government 2012 | 1

Using social media to drive health information Features on staff and community workers and chronic clubs Western Cape Government 2012 | 42 Thank you Thank you for availing an opportunity to Khayelitsha district hospital to do a presentation to honourable committee members. Western Cape Government 2012 |

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