On-line version ISSN 2309-8309
SA orthop. j. vol.8 n.1 Pretoria Jan. 2009
MBChB, Dip PEC(SA), HDipOrth(SA), FC(Orth)(SA); Consultant, Department of Orthopaedic Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal
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.
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Dr ND Naidoo
Department of Orthopaedic Surgery
Nelson R Mandela School of Medicine, University of KwaZulu-Natal
Private Bag X7
Tel: (031) 260-4297; Fax: (031) 260-4518
The content of this article is the sole work of the authors. No benefits of any form have been derived from any commercial party related directly or indirectly to the subject of this article.