Author: Abdulslam Mohammed , 2022                                                                                                                                                                               Principal Nursing Officer (Korle-Bu Teaching Hospital)/ CEO/ Co-Founder: Oxygen Health- Digital Health Marketplace.

Preamble: The purpose of this paper is to underscore the major causes and contributing factors of the most critical problem, No-bed syndrome (congestion) affecting the health sector in Ghana and most African Countries as whole. Korle-bu Teaching Hospital is Ghana's premier hospital and highest specialist hospital with over 3000 bed capacity.This purpose of this abstract is examine available literature to establish a conceptual framework about factors leading to congestion in hospitals, lack of access to health care in Africa and underpins the position and conclusions that, incorporating digital health care and home based health care approaches in Africa is a great panacea for mitigating these contributing factors of lack of access to health care.

Home Health Care, a commonly used bridge strategy for transitioning from hospital to home-based care, contribute to readmission avoidance efforts. Home care services has been linked to reduction in length of patient stay https://www.researchgate.net/publication/344257353Does_formal_home_care_reduce_inpatient_length_of_stay . Data shows home health visits can reduce the likelihood of hospital readmission by as much as 25%. When integrated into the continuum of care, home health helps ensure that patients discharged from acute care settings and skilled nursing facilities do not suffer relapses that require re-hospitalization. In a systematic review of heart failure patients published in the Annals of Internal Medicine, home nursing visits reduced readmissions and mortality for as long as six months. https://pubmed.ncbi.nlm.nih.gov/24862840/

Digital Health Care, Access to healthcare services has been impacted by a number of innovations including electronic health record, artificial intelligence, sensors, wearable devices, Internet of (medical) things, Blockchain, big data and other applications. COVID-19 has created new realities in accessing healthcare services through telehealth and telemedicine services. https://www.intechopen.com/chapters/78328. WHO (2016) confirmed that “It has become increasingly clear that UHC cannot be achieved without the support of eHealth. World Health Organization. Research for universal health coverage: World health report 2013. Geneva: WHO, 2013,

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INTEGRATION OF HOME BASED AND DIGITAL HEALTH CARE: MITIGATING FACTORS THAT LEAD TO NO-BED SYNDROME AND PROLONGED LENGTH OF PATIENT STAY IN GHANA.

STATEMENT OF PROBLEM :

Honey, J. (2017, April) established the correlation between length of stay and overcrowding; termed No-Bed Syndrome (NBS) in Ghanaian Health System. Data shows that, The NBS at the emergency unit of Korle-Bu Teaching Hospital(KBTH), built in 1923 with over 2000 bed capacity, Ghana's premier Hospital, is positively correlated with prolonged hospital stay of patients at the medical ward, because over fifty percent (50%) of cases presented at the Emergency Department are medical related. With many reports of patients losing life due to The NBS. The issue became a subject of many media publications, commentary from the general public, including the Parliament of Ghana proposing criminalization of the act. The purpose of this paper is to develop a conceptual framework to underscore the major causes and contributing factors of the problem and assess how integration of home care and digital health care can mitigate these factors .

METHODOLOGY :

This study reviewed available literature and studies on the subject matter .Retrospective analysis of data on cases presented at the emergency unit of KBTH was done. In-depth interviews with a cross section of health professionals regarding reasons for prolonged length of stay and the no-bed syndrome was conducted. FINDINGS: Prolonged Hospital stay of patients in KBTH is affected by four main interlinked factors emanating from patients, health staff, the facility and external complimentary system. Delay in discharge planning and Lack of effective usage of computerized clinical decisions delays clinical judgements of doctors. No integration of home care prolonged the stay of most patients with chronic conditions, who otherwise could have been discharged earlier to free beds for acute cases. Many studies have also linked home care services with reduction and length of stay and risk for hospital readmission by about 25%. “It has become increasingly clear that UHC cannot be achieved without the support of e-Health.(WHO)

RECOMMENDATIONS:

National Stakeholders must develop policies to integrate and regulate home and digital health care in the mainstream health service to improve quality, solve critical problems and improve on access to health care

REFERENCES

Agyeman, Badu Akosa (2018, June). ‘No bed’ syndrome, a telling phenomenon of Ghana’ health care. Daily Graphic. https://www.graphic.com.gh/features/opinion/no-bedsyndrome-a-telling-phenomenon-of-ghana-s-health-care.html

Honey,J. (2017,April) “No Bed Syndrome”: Unmet Demand for Hospital Beds in the Emergency Department (ED) of Komfo Anokye Teaching Hospital (KATH). Pre Hospital and Disaster Management Journal: https://www.researchgate.net/publication/316304172_No_Bed_Syndrome_Unmet_Demand_for_Hos pital_Beds_in_the_Emergency_Department_ED_of_Komfo_Anokye_Teaching_H ospital_KATH#

Hyunyoung Baek, Minsu Cho, Sooyoung Yoo ; Analysis of length of hospital stay using electronic health records : A statistical and data mining approach.

Monica, K. (2018,December).HER Use Helps to reduce hospital readmissions, length of stays analysis of data from Carlifornia office of statewide health planning and development (OSHPD) ,patients from 2010-2013.

EHR Intelligence www.ehrintelligence.com https://www.researchgate.net/publication/344257353_Does_formal_home_care_reduce_in patient_length_of_stay.