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SA Orthopaedic Journal

On-line version ISSN 2309-8309

SA orthop. j. vol.8 n.1 Pretoria Jan. 2009

 

CLINICAL ARTICLE

 

An evaluation of the quality of orthopaedic trauma referrals to a regional hospital

 

 

ND Naidoo

MBChB, Dip PEC(SA), HDipOrth(SA), FC(Orth)(SA); Consultant, Department of Orthopaedic Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal

Correspondence

 

 


ABSTRACT

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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Correspondence:
Dr ND Naidoo
Department of Orthopaedic Surgery
Nelson R Mandela School of Medicine, University of KwaZulu-Natal
Private Bag X7
Congella, 4013
Tel: (031) 260-4297; Fax: (031) 260-4518
Email: naven33@webmail.co.za

 

 

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