Audit of the referred patients to a tertiary centre: a tool for need assessment

Abstract

Background: The referred patient is often regarded to as 'unbooked' at the referral centers and are most often categorized as high risk. Referrals are associated with delays which increases the morbidity and mortality pattern.
Objective: The audit of the referral patterns to a tertiary center is to assist in identifying gaps in management; needs assessment and areas that that can be bridged to reduce the complications that are associated with the unbooked patient.
Design: This was a retrospective study of consecutive patients that were referred to the hospital from July 2012 to June 2013. A proforma form was developed to enter the data of the patients.
Setting: The study was conducted in Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun state in South West of Nigeria. It is a referral centre that serves major towns and villages.
Subjects: One hundred and twenty five consecutive patients referred to the obstetric emergency room were used for the study.
Results: A total of 811 patients were admitted into the labour ward during the one year period with 15.4% of them unbooked. Only about half of the patients came with a referral letter (52.8%) and the referral was initiated by nurses in 43.2% of the cases. Sixty eight percent of the referrals were within 5 km radius to the referring centre and 23% were 45-50 km from the hospital. There was no statistical significance between fetal and maternal outcome and the source of referral (P> 0.05). The reason for referral in most cases (65.6%) was because of lack of expertise for management and 24.8% due to need for surgery. Using the Anaesthetic Standard of Assessment as a prototype, 72.8% of the patients were ASA 1 on admission and 78.2% of the babies were alive on arrival in OOUTH though 20.8% of them suffered moderate to severe asphyxia at birth Mean arrival-admission interval was 92.2mins and the arrival-definitive intervention time was 220.7 minutes.
Conclusion: Acute shortage of personnel and equipments are the main reason why patients are referred for treatment and most of this will be avoidable if adequate facilities exist. Labour room staffs also need to be retrained and closely supervised to reduce the rate of wrong diagnosis which reduces number of referrals. Improving capacity at the peripheral centers will reduce the rate of referrals and reduce significantly maternal morbidity and mortality.