title: The consequences upon patient care of moving Brits Hospital: a case study.
abstract: BACKGROUND
  In 2001, North West Province took the decision to increase bed capacity at Brits Hospital from 66 beds to 267 beds. After careful consideration of costs and an assessment of available land, it was decided to demolish the existing hospital and rebuild the new hospital on the same site. It was planned that during this time that clinical services would be moved to a temporary makeshift hospital and to primary health care clinics. This case study documents the consequences of this decision to move services to the makeshift hospital and how these challenges were dealt with.
  
  
  METHODS
  A cross-sectional descriptive study was undertaken. Ten key members of staff at management and service delivery level, in the hospital and the district, were interviewed. Key documents, reports, correspondence, hospital statistics and minutes of meetings related to the move were analysed.
  
  
  RESULTS
  The plan had several unforeseen consequences with serious effects on patient care. Maternity services were particularly affected. Maternity beds decreased from 30 beds in the former hospital to 4 beds in the makeshift hospital. As numbers of deliveries did not greatly decrease, this resulted in severe overcrowding, making monitoring and care difficult. Perinatal mortality rates doubled after the move. An increase in maternal deaths was noted. The lack of inpatient ward space resulted in severe overcrowding in Casualty. The lack of X-ray facilities necessitated patients being referred to a facility 72 km away, which often caused a delay of 3 days before management was completed. After-hours X-rays were done in a private facility, adding to unforeseen costs. Although the initial plan was for the makeshift hospital to stabilise and refer most patients, referral routes were not agreed upon or put in writing, and no extra transportation resources were allocated. The pharmacy had insufficient space for storage of medication. In spite of all these issues, relationships and capacity at clinics were strengthened, but not sufficiently to meet the need.
  
  
  CONCLUSIONS
  Hospital revitalisation requires detailed planning so that services are not disrupted. Several case studies have highlighted the planning necessary when services are to be moved temporarily. Makeshift hospitals have been used when renovating or building hospitals. During war or disasters, plans have been made to decant patients from one facility to another. From the Brits case study, it would appear that not enough detailed planning for the move was done initially. This observation includes failure to appreciate the interrelatedness of systems and the practicality of the proposal, and to budget for the move and not just the new structure.
  
  
  CONCLUSIONS
  The current service offered at the makeshift hospital at Brits is not adequate and has resulted in poor patient care. It is the result of a planning process that did not examine the consequences of the move, both logistic and financial, in adequate detail. Committed hospital staff have tried their best to offer good care in difficult circumstances.
authors.affiliation: Centre for Rural Health, University of the Witwatersrand, Johannesburg. colinpfaff@yahoo.co.uk
authors.forename: C A
authors.initials: CA
authors.lastname: Pfaff
authors.forename: I D
authors.initials: ID
authors.lastname: Couper
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D006271:Health Facility Closure; D006742:Hospital Bed Capacity; D006749:Hospital Design and Construction; D006767:Hospitals, District / Q000458:organization & administration*; D006801:Humans; D010360:Patient Transfer / Q000458:organization & administration*; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000458:organization & administration; D012040:Regional Health Planning / Q000458:organization & administration*; D013019:South Africa