The impact of a change in referral pathway on a paediatric short-stay ward in Cape Town, South Africa

Abstract

Background. The opening of the new Khayelitsha District Hospital in April 2012 coincided with a change in referral pathway to Tygerberg Hospital (TBH) for children requiring specialist care.

Objective. To determine the disease burden impact of the referral pathway change on paediatric short-stay ward admissions at TBH.

Methods. A retrospective cohort study, analysing routine health information as captured in ward admissions registers over two similar seasonal periods: 1 April - 30 September 2011 (prior to referral change) and 1 April - 30 September 2012 (post referral change).

Results. Paediatric short-stay ward admissions remained similar, but a statistically significant increase in the number of admissions from Khayelitsha sub-district (SD) (p<0.001) was seen. The median age was 13 months over the two time periods. Children from Khayelitsha (median age 9.49 months for 2011 and 5.2 months for 2012) were, however, significantly younger than those from other SDs (median age 26.31 months in 2011 and 26.44 months in 2012) (p=0.001). Khayelitsha children were more likely to require admission to a TBH paediatric ward (p<0.001, adjusted odds ratio (aOR) 0.57), while children from other SDs were more likely to be discharged home or transferred to a district hospital (p<0.001, aOR 1.75). Respiratory illnesses accounted for the majority of admissions during both time periods (54% in 2011 and 51% in 2012).

Conclusion. Children from Khayelitsha were significantly younger and more likely to be admitted to a TBH inpatient ward compared with other SDs. These findings necessitate a review of current health service resource allocation.