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

*

* 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.

*

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

*