SciELO - Scientific Electronic Library Online

vol.8 issue1Post-exposure prophylaxis (PEP): A practical guidePart II: Metabolic bone disease: Recent developments in the pathogenesis of rickets, osteomalacia and age-related osteoporosis author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand



Related links

  • On index processCited by Google
  • On index processSimilars in Google


SA Orthopaedic Journal

On-line version ISSN 2309-8309
Print version ISSN 1681-150X

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




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





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.



“Full text available only in PDF format”




1. 7.         [ Links ]

2. De Prado Prieto L, Garcia Olmos L, Rodrigues Salvanes F, Otero Puime A. Evaluation of referrals in primary care. Aten Primaria 2005;28;35(3):146-51.         [ Links ]

3. Piterman L, Korsitas S. General practitioner - specialist referral process. Intern Med J 2005;35(8):491-6.         [ Links ]

4. Nyman JA, Manning WG, Samuels S, Morrey BF. Can specialists reduce costs? The case of referrals to orthopaedic surgeons. Clin Orthop 1998;350:257-67.         [ Links ]

5. Beggs I. Repeat radiographs in GP referrals to an orthopaedic clinic. Br J Gen Pract 1997;47(418):313.         [ Links ]

6. Kremli MK. Missed musculoskeletal injuries in a University Hospital in Riyadh: types of missed injuries and responsible factors. Injury 1996;27(7):503-6.         [ Links ]

7. Wardrope J, Chennels PM. Should all casualty radiographs be reviewed? Br Med J 1985;290:1638-40.         [ Links ]

8. Morton RJ. Fracture clinic referrals: the need for self audit. Injury 1988;19(2):77-8.         [ Links ]

9. American College of Surgeons Committee on Trauma: Advanced Trauma Life Support Stud Ed 1997;327-35.         [ Links ]

10. Lee C, Porter KM. Prehospital management of lower limb fractures. Emerg Med J 2005;22(9):660-3.         [ Links ]

11. Gosselin RA, Roberts I, Gillespie J. Antibiotics for preventing infection in open fractures. Cochrane Database Syst review 2004;(1)CD003764.         [ Links ]

12. Ashford RV, Frasquet-Garcia A, Patel KK, Campbell P. Delays in open fracture management: where do they occur? Injury 2004;35(11):1107-9.         [ Links ]

13. Zalavras CG, Patzakis MJ. Open fractures: evaluation and management. J Am Acad Orth Surg 2003;11(3):212-9.         [ Links ]

14. Robertson R, Mattox R, Collins T, Parks-Miller C, Eldt J, Cone J. Missed injuries in a rural area trauma centre. Am J Surg 1996;172:564-8.         [ Links ]



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



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.

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License