SA Orthopaedic Journal
On-line version ISSN 2309-8309
NAIDOO, ND. An evaluation of the quality of orthopaedic trauma referrals to a regional hospital. SA orthop. j. [online]. 2009, vol.8, n.1, pp. 66-69. ISSN 2309-8309.
BACKGROUND: The purpose of this prospective study was to assess patient referrals to a regional hospital with respect to communication, quality of referral letters, transfer times, investigations, diagnostic accuracy, initial management as well as associated and missed injuries. METHOD: All in all 88 patient referrals were assessed prospectively over four months by a single investigator utilising a questionnaire. RESULTS: The average age was 41 years. Eighteen of the injuries (20%) were compound fractures. The average transfer time of closed injuries was 10 hours and 8 minutes and for compound injuries it was 4 hours and 20 minutes. Twenty patients (23%) were not discussed prior to transfer. Referring doctor details were deficient regarding the name 10 (11%), contact details 58 (66%) and designation 82 (93%). No receiving physician was listed in 23 (26%) referrals. Deficiencies were noted in describing the mechanism of injury (58%), time of injury (47%), type of splinting (60%) and type of analgesia (12%). Referrals of compound fractures showed a description of wound care in 11 (61%) referrals, antibiotic therapy in 9 (50%) and tetanus prophylaxis in 3 (16%). A total of 53 (60%) referrals presented without haematological investigations and 84 (95%) presented with radiological investigations, of which 54 (64%) were inadequate. Diagnostic errors emerged in 16% of referrals with a missed injury rate of 10%. CONCLUSION: Supervision, training and regular assessment of junior doctors is essential to improve the quality of patient care by the referring hospitals.