Patterns, quality and appropriateness of surgical referrals in Malawi
- 23 April 2020
- journal article
- research article
- Published by Wiley in Tropical Medicine & International Health
- Vol. 25 (7), 824-833
- https://doi.org/10.1111/tmi.13406
Abstract
Objectives Reliable referral systems are essential to the functionality and efficiency of the wider health care system in low‐ and middle‐income countries (LMICs), particularly in surgery as the disease burden is growing while resources remain constrained and unevenly distributed. Yet, this is a critically under‐researched area. This study aimed to provide a comprehensive assessment of surgical referral systems in a LMIC, Malawi, with a view to shedding light on this important aspect of public health and share lessons learned. Methods We conducted a prospective analysis of all inter‐hospital referrals received at Queen Elizabeth Central Hospital (QECH) in 2014‐2015. A subsample of 255 referrals was assessed by three independent surgical experts against necessity and quality of the transfer to identify any inefficiencies in the referral process. Results 1317 patients were referred to QECH during the study period (average 53/month), 80% sent by government district hospitals. 1 in 3 cases were referred unnecessarily, many of which could have been managed locally. In 82% of cases there was no communication with QECH prior to referral, 41% had incorrect/incomplete diagnosis by the referring clinicians and 39% of referrals were not timely. Conclusions our findings provide the first evidence on the state of the surgical referral system in Malawi and contribute to building the body of knowledge necessary to inform system improvements. Responses should include reducing inappropriate use of specialist care and ensuring better care pathways for surgical patients, especially in rural areas, where access to specialist expertise is not available at present.Keywords
This publication has 19 references indexed in Scilit:
- Who accesses surgery at district level in sub‐Saharan Africa? Evidence from Malawi and ZambiaTropical Medicine & International Health, 2017
- Task sharing within a managed clinical network to improve child health in MalawiHuman Resources for Health, 2015
- Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic developmentSurgery, 2015
- Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic developmentThe Lancet, 2015
- Quality of referrals for elective surgery at a tertiary care hospital in a developing country: An opportunity for improving timely access to and cost-effectiveness of surgical careInternational Journal of Surgery, 2015
- Essential Surgery: The Way ForwardWorld Journal of Surgery, 2015
- Surgical and anaesthetic capacity of hospitals in Malawi: key insightsHealth Policy and Planning, 2014
- Interpretations of referral appropriateness by senior health managers in five PCT areas in England: a qualitative investigationQuality and Safety in Health Care, 2010
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational StudiesPLoS Medicine, 2007
- Surgery in Malawi – A National Survey of Activity in Rural and Urban HospitalsThe Annals of The Royal College of Surgeons of England, 2007