Abstract
Background: Non-escalation of patient care, particularly prevalent in high-care settings like the Paediatrics Unit of Chris Hani Baragwanath Hospital (Bara), poses significant challenges. Resource constraints, communication barriers, and ethical dilemmas contribute to this phenomenon, impacting both patient outcomes and the well-being of healthcare workers. The Paediatrics High Care Unit at Bara caters to critically ill children who require intensive monitoring but do not meet the criteria for intensive care unit admission. This unit primarily serves a population drawn from socioeconomically disadvantaged communities.
Methodology: A quantitative cross-sectional study design was employed to investigate the phenomenon among selected participants. The study population comprised 350 healthcare professionals working in the Paediatrics High Care Unit at Bara, including paediatricians, nurses, medical officers, nursing managers, unit heads, and allied workers directly involved in patient care. A census approach was adopted, whereby a self-administered questionnaire was distributed to every member of the population. Data was analysed using IBM SPSS Statistics version 30.0. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize demographic characteristics, the prevalence of non-escalation of care, and associated factors. Inferential statistics such as Chi-square tests were conducted to examine associations between categorical variables, including demographic factors and the occurrence of non-escalation events. Linear regression analyses were performed to identify significant predictors of non-escalation of care among healthcare workers. A significance level of p < 0.05 was used throughout the analysis.
Results: The study revealed that the largest proportion of health care workers (36.0%) were between the ages of 40 and 50 years, with the majority being female (71.9%), African (77.8%), and employed as nurses (54.3%). Most respondents had four to six years of work experience. The prevalence of non-escalation of care was found to be 44.8% among healthcare personnel who reported frequent non-escalation of incidents, and 54.7% among those who experienced such events less frequently. Statistically significant associations were identified between the healthcare worker’s role and non-
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escalation events. The overall workload burden in the Paediatrics High Care unit was significantly linked to non-escalation of care (p = 0.041). Time pressure experienced during shifts was also significantly associated with non-escalation (p < 0.001), as was psychological stress related to workload (p < 0.001). In addition, the degree of satisfaction with communication clarity within the healthcare team when handling patient escalations was significantly associated with non-escalation events (p = 0.007). Nearly all participants agreed that several interventions could improve the escalation of care in the unit: improving training (98.0%), strengthening communication protocols (99.5%), increasing staffing levels (100%), enhancing resource allocation (99.5%), and providing emotional support and regular debriefing sessions (99.5%).
Conclusion: The study offered a critical analysis of the prevalence and determinants of non-escalation of care among healthcare workers in a paediatrics high care setting. A high prevalence of non-escalation was observed, with statistically significant associations identified in relation to race, workload, time pressure, psychological stress, and communication clarity. No significant associations were found with gender, age, role, or training satisfaction.