P-10 Prospective study of limited high-dependency unit space on emergency patient outcomes in Guyana

Methods: This prospective study included 116 patients admitted to the HDU from the A&E Department and 60 medical personnel. Patient demographics, admission details, bed availability, and outcomes were collected using a data collection tool developed by the team. Challenges and staff suggestions were collected through an online survey.

Results: The mean age of patients was 48 years, with a female-to-male ratio of approximately 1:1.2. Comorbidities were prevalent in 64.7% of patients, with hypertension and type 2 diabetes mellitus being the most common. A critical supply-demand mismatch was identified with accumulated bed demand (193) exceeding availability (43) (or demand 4.49 times higher than what was available). Consequently, 85.3% (N=99) of patients experienced “boarding” delays in the A&E, and only 37.1% (N=43) were successfully transferred to the HDU. While the overall mortality rate was 29.3% (N=34), no statistically significant association was found between successful HDU transfer and survival (p=0.867) Survey responses indicated significant concerns about inadequate HDU space, staffing, and patient flow management and offered actionable recommendations with emerging themes.

Conclusion: GPHC faces a systemic resource deficit where infrastructure limitations force a reliance on human resilience to maintain patient safety. While compensatory care currently masks mortality risks, the system could reach a critical “tipping point.” Survey responses revealed a consensus on the need for enhanced HDU space, increased staffing, and better patient flow management.