Determinants of referral among patients transferred for emergency surgical operation from secondary level hospitals to tertiary level hospitals in Dar es salaam region, June - October 2013
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Date
2013
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Hubert Kairuki Memorial University
Abstract
OBJECTIVE: To assess the determinants of referred patients for emergency surgicai operation
from second level hospitals to tertiary level hospitals in Dar es Salaam region. Little information is
documented for the determinants of referral of general surgery patients for emergency operations.
METHODOLOGY: The cross-sectional descriptive hospital based study, conducted at
emergency department of MNH in a period of five months in 2013. A total of 363 patients were
referred from second level hospitals to tertiary level hospital in Dar es Salaam region during the
study period.
RESULTS: The determinants grouped into four main groups and several small sub groups in each
main group. The 62.5% of referred patients required urgent attention and the remaining 37.5%
were cold cases.
The type of disease/diagnosis was first main group; the leading referral disease about half of all
referrals due to diseases were musculoskeletal conditions 50.7%, followed by gastrointestinal
diseases 26.7%.
Lack or shortage of the health personnel was second main group; The leading shortage of
personnel was about 36.6% referrals was due to the shortage of General Surgeons, 29.8% due to
shortage of Orthopedic Surgeons and 15.15% referrals due to shortage ofNeurosurgeons.
The lack of equipment was third main group; leading factor was lack of investigation services
about 33.3% referrals, lack of sterile gauze at the theaters was about 24.8% and lack of sterile trays
for surgeries was about 18.5%.
The insufficient infrastructure was fourth main group; leading factor were due to overcrowding of
patients in the surgical wards about 68.9% referred patients due to few beds in the surgical wards,
followed by lack of ICU facility about 16.0% of referred patients and overcrowding of patients
waiting theatre service 15.2%.
Only 25.3% of all referred patients were due to patient's request (or self referral) and
Mwananyamala hospital was the leading hospital for referring many patients, for about 53.4% of
referred patients.
CONCLUSIONS: The determinants of the referred surgical patients showed some similarities and
difference in some aspects, to other studies done in Tanzania and in Africa. High rate of referral of
general surgical patients for emergency treatments to tertiary level hospital could be minimized if;
theatre, surgical clinics standards and management are followed at the second level facilities.
Description
A dissertation submitted in partial fulfillment of the requirements for the
degree of Master of Medicine in General surgery of the Hubert Kairuki
Memorial University (HKMU) Dar es Salaam, Tanzania.
Keywords
Emergency surgical operation, Secondary to tertiary level hospital, Dar es salaam region
Citation
Mwamkoa, L. L., 2013. Determinants of referral among patients transferred for emergency surgical operation from secondary level hospitals to tertiary level hospitals in Dar es salaam region, June - October 2013. HKMU