Applying the three delays qualitative model to sepsis care seeking and emergency care in a private hospital in Lagos, Nigeria.

BACKGROUND: Sepsis remains a leading cause of death among hospitalized and critically ill patients in Nigeria. Despite progress in antimicrobial therapy access and emergency resuscitative care, it continues to account for a significant proportion of death and disability in low and middle-income countries and represents a significant burden of disease. This study aimed to define the factors impacting patient care-seeking and clinician emergency care practices for septic patients at a private hospital in Lagos, Nigeria. METHODS: The study explored barriers to providing care among clinicians in group discussions using the three-delays model. Patients or caregivers completed in-depth interviews to explain barriers to seeking care. The study used pilot-tested, semi-structured group/interview guides to facilitate data collection from patients and clinicians. Interviews/group discussions were audiotaped, transcribed, and coded. Data was collected and analyzed until thematic saturation was achieved. RESULTS: A total of 15 clinicians and 30 patients or caregivers participated. Delays in seeking appropriate care (Delay 1) included seeking alternative sources of care, communal or family decision-making issues, and symptom and illness perception. For delay 2 (reaching appropriate care), work schedule considerations, proximity to the healthcare facility, mode of transportation, and patients' time preference for hospital presentation emerged as common themes. In delay 3 (receiving appropriate care), the clinical condition at presentation, the selected clinical approach to management, system delays at the hospital, and financial considerations impacted the time to provision of definitive care. CONCLUSIONS: Delays in patient healthcare-seeking and clinician delivery of emergency stabilization in sepsis occur in Nigeria and align with the three-delays model. The decision to seek care (delay1) is frequently made communally with family and friends. Patients initially prefer alternative sources of care for convenience. Upon arriving at the hospital for appropriate care (delay 2), work schedule considerations, long commute times to the hospital, and long waiting times impacted patients' time to arrival. Finally, receiving definitive care (delay 3) was affected by financial considerations, clinicians' knowledge of sepsis symptom management and treatment, and delays in completing diagnostic laboratory investigations.

Duke Scholars

Author Catherine Ann Staton Emergency Medicine