TY - JOUR
T1 - Defining the Three Delays in Referral of Surgical Emergencies from District Hospitals to University Teaching Hospital of Kigali, Rwanda
AU - Mpirimbanyi, Christophe
AU - Abahuje, Egide
AU - Hirwa, Aime Dieudone
AU - Gasakure, Miguel
AU - Rwagahirima, Elisee
AU - Niyonzima, Christian
AU - Hakizimana, Adolphe Niyoyita
AU - Ishimwe, Epiphanie
AU - Ntirenganya, Faustin
AU - Rickard, Jennifer
N1 - Publisher Copyright:
© 2019, Société Internationale de Chirurgie.
PY - 2019/8/15
Y1 - 2019/8/15
N2 - Background: Surgical conditions represent up to 30% of the global burden of diseases. The aim of this study was to assess the delays in patients transferred to a tertiary referral hospital from district hospitals (DHs) in Rwanda with emergency general surgery (EGS) conditions. Methods: We performed a prospective review of all EGS patients referred from DH over a 3-month period to assess delays in transfer and accessing care. We then surveyed general practitioners to define their perspective on delays in surgical care. Results: Over a 3-month period, there were 86 patients transferred from DH with EGS conditions. The most common diagnoses were bowel obstruction (n = 22, 26%) and trauma (n = 19, 22%). The most common performed operations were laparotomy (n = 21, 24%) and bowel resection (n = 20, 23%). The mortality rate was 12%, and the intensive care unit admission rate was 4%. In transfer to the referral hospital, 5% patients were delayed for financial reasons and 2% due to lack of insurance. After reaching CHUK, 5% patients were delayed due to laboratory and radiology issues. Other delays included no operating theater available (4%) and no surgeon available (1%). Providers’ perceptions for not performing surgeries at DH were predominantly the lack of a competent surgical provider or anesthesia staff. Conclusion: EGS patients represent a broad range of diagnoses. Delays were noted at each step in the referral process with multiple areas for potential improvement. Expanding surgical access at the DH has the potential to decrease delays and thereby improves patient outcomes.
AB - Background: Surgical conditions represent up to 30% of the global burden of diseases. The aim of this study was to assess the delays in patients transferred to a tertiary referral hospital from district hospitals (DHs) in Rwanda with emergency general surgery (EGS) conditions. Methods: We performed a prospective review of all EGS patients referred from DH over a 3-month period to assess delays in transfer and accessing care. We then surveyed general practitioners to define their perspective on delays in surgical care. Results: Over a 3-month period, there were 86 patients transferred from DH with EGS conditions. The most common diagnoses were bowel obstruction (n = 22, 26%) and trauma (n = 19, 22%). The most common performed operations were laparotomy (n = 21, 24%) and bowel resection (n = 20, 23%). The mortality rate was 12%, and the intensive care unit admission rate was 4%. In transfer to the referral hospital, 5% patients were delayed for financial reasons and 2% due to lack of insurance. After reaching CHUK, 5% patients were delayed due to laboratory and radiology issues. Other delays included no operating theater available (4%) and no surgeon available (1%). Providers’ perceptions for not performing surgeries at DH were predominantly the lack of a competent surgical provider or anesthesia staff. Conclusion: EGS patients represent a broad range of diagnoses. Delays were noted at each step in the referral process with multiple areas for potential improvement. Expanding surgical access at the DH has the potential to decrease delays and thereby improves patient outcomes.
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U2 - 10.1007/s00268-019-04991-3
DO - 10.1007/s00268-019-04991-3
M3 - Article
C2 - 30944958
AN - SCOPUS:85064264337
SN - 0364-2313
VL - 43
SP - 1871
EP - 1879
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 8
ER -