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Elisa Pujals, MSIV, MPH
2012 GE NMF Ghana Scholar
Mentor: Dr. Akye Essuman, MD
*
*Key element of safe motherhood, IMCI malaria management, emergency care
and rural health programs
*Identified as area for improvement throughout Africa and other developing
nations
*Referral practices complex process influenced by infrastructure and
sociocultural factors
*In order to strengthen referral systems, we must identify and understand
successful practices
*
* “How do referrals policies translate to practice at the
district hospital level?”
*
1) Undertake a systematic and accurate review of patient referrals at Kintampo Municipal Hospital’s emergency medicine ward
2) Enhance knowledge of the emergency service needs met at the district hospital level
3) Identify network of referring health centers and morbidity trends from different regions
4) Assess the district hospital’s referral patterns to other hospital facilities and capacity to treat patients
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* a cross-sectional analysis of referral practices in the emergency ward
* chart review in three hospital wards (emergency, surgical/medical, maternity)
* structured interviews with the emergency ward senior staff nurses and physician assistant, on
referral policies and practices.
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Cross Sectional Analysis
From March 23, 2012 to April 13, 2012 KMH EW received 16
referred cases
27%
13%
13%6%
20%
7%
7%
7%
Cases referred to EWMarch 26 - April 13, 2012
Anemia from Malaria
Trauma
Pneumonia
Septic hand
Abdominal Pain
GE
allergic reaction
hypertension
0
1
2
3
4
5
Clinics referring to KMH Emergency Ward
Females
Males
RC - Rural Clinic
HC - Health Center
CHPS - Community
Health Planning
Services Compound
MH - Maternity Home
*
*
Records Review
Referral cases from
January 1, 2012 to present
Maternity Ward – no entries in “referral book” since 2011. Delivery
book used to document incoming referrals. Ward “changes” book
documented 2 cases as referred out since Jan. 2012.
Question Staff Nurse Staff Nurse Medical Assistant
Do you know the most
common referring clinics or
health centers?
Don’t know Subdistricts refer
cases they can’t
manage to
municipal hospital
Not sure
What are the most common
reasons for referring to
Kintampo?
« no labs » « severe
anemia and cant
transfuse and snake
bites »
Typhoid
perforations,
severe malaria,
snakebites
For labs and x-rays
What are the most common
reasons you refer out?
« beyond our
management »
« fractures and
orthopedic cases »
Complete and
compound
fractures, head
injuries
For further
management of
fractures, heart and
liver problems
Where do you refer most
often?
« Depends on gravity.
Sunyani and we refer
orthopedic cases to
Techiman
First Sunyani.
Techiman for CT
scans and simple
fractures »
Sunyani
Interviews
*
*KMH responds to many referrals that benefit from labs, theatre, midwives, staff
*People referred from in and outside the district
*Most referrals out due to fractures, CT scan and specialist care
*Staff is aware of procedures
*Gaps between policy and practice
*
*Time constraints
*Reliance on staff informants
*Did not include referrals from OPD
*
* Empower staff to conduct similar analyses on quarterly or bi-annual basis
*Review documentation policies and provide supplies for simple, consistent records
*Strengthen communication with referral network and organize cross district trainings
*