Abstract
The purpose of this prospective study was to assess the patient referrals to King Edward V111 hospital with respect to communication, quality of referral letters, transfer times, investigations, diagnostic accuracy, initial management, associated and missed injuries.
88 Patient referrals were assessed prospectively over 4 months by a single investigator utilizing a questionnaire. The average age was 41 years. Eighteen (20%) were compound fractures. The average transfer time of closed injuries was 10h08 and compound injuries 4h20. 20 Patients (23%) were not discussed prior to transfer and 1 (1%) patient did not present with a referral letter. Referring physician details were deficient in name 10 (11%), contact details 58 (66%) and designation 82 (93%). No receiving physician was listed in 23 (26%) referrals. Mechanism of injury was provided in 51 (58%) referrals, time of injury in 41 (47%), type of splinting in 53 (60%) and type of analgesia in 11 (12%) referrals. 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%). 53 (60%) referrals presented without haematological investigations and 84 (95%) presented with radiological investigations of which 54 (64%) were inadequate. Splinting was satisfactory in 35 (40%) and analgesia was adequate in 9 (10%). Wound care was appropriate in only 5 (27%) and antibiotics were administered in 7 (39%) compound fractures. Diagnostic errors emerged in 14 (16%) of referrals with a missed injury rate of 10% (9 pts). 1 Patient required urgent intervention due to blunt abdominal trauma.
Supervision, training and regular assessment of junior doctors is essential to improve the quality of patient care by the referring hospitals.
Correspondence should be addressed to: Léana Fourie, CEO SAOA, PO Box 12918, Brandhof 9324 South Africa.
