Theoneste Nkurunziza1, Gabriel Toma2, Jackline Odhiambo3, Rebecca Maine4, Robert Riviello5, Neil Gupta6, Caste Habiyakare7, Tharcisse Mpunga7, Alex Bonane8, Bethany Hedt-Gauthier2. 1. Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda. Electronic address: theonkrz@gmail.com. 2. Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA. 3. Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda. 4. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Department of Surgery, University of California, San Francisco, CA. 5. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; University Teaching Hospital, Kigali, Rwanda. 6. Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Brigham and Women's Hospital, Boston, MA. 7. Ministry of Health, Kigali, Rwanda. 8. University Teaching Hospital, Kigali, Rwanda; University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.
Abstract
BACKGROUND: In developing countries, 9 out of 10 patients lack access to timely operative care. Most patients seek care at district hospitals that often lack operative capacity, creating a need for referral. Delays in referrals contribute to substantial disability and death. This study assessed the predictors of delayed referrals for injured patients. METHODS: This retrospective cohort study included injured patients, recommended for referral between January 1, 2013, and December 31, 2013, from 3 rural district hospitals in Rwanda. We defined delay as nonexecution of referral 2 days after referral recommendation. We performed a multivariate logistic regression using stepwise backward selection to identify the predictors of delayed referral. RESULTS: Of the 1,227 injured patients, 23.0% (n = 282) were recommended for referral. Of these, 36.5% (n = 103) had road traffic injuries and 53.6% (n = 151) were diagnosed with closed fractures/dislocation. Among 231 patients, 108 (46.8%) had a delay in referral execution. The predictors of delay included age >35 years (odds ratio = 2.45, 95% confidence interval: 1.09-5.50), closed fractures/dislocation (odds ratio = 16.37, 95% confidence interval: 3.13-85.78), admission to surgical wards (odds ratio = 10.25, 95% confidence interval: 2.70-38.82), and a duration ≥7 days from admission to referral recommendation (odds ratio = 4.80, 95% confidence interval: 1.38-16.63). CONCLUSION: Over 50% of referrals were completed in a timely fashion due to a strong referral system and a patient support program. Empowering district hospitals with trained staff and appropriate equipment could reduce the need for referral, and increasing surgeons at referral hospitals could reduce referral delays.
BACKGROUND: In developing countries, 9 out of 10 patients lack access to timely operative care. Most patients seek care at district hospitals that often lack operative capacity, creating a need for referral. Delays in referrals contribute to substantial disability and death. This study assessed the predictors of delayed referrals for injured patients. METHODS: This retrospective cohort study included injured patients, recommended for referral between January 1, 2013, and December 31, 2013, from 3 rural district hospitals in Rwanda. We defined delay as nonexecution of referral 2 days after referral recommendation. We performed a multivariate logistic regression using stepwise backward selection to identify the predictors of delayed referral. RESULTS: Of the 1,227 injured patients, 23.0% (n = 282) were recommended for referral. Of these, 36.5% (n = 103) had road traffic injuries and 53.6% (n = 151) were diagnosed with closed fractures/dislocation. Among 231 patients, 108 (46.8%) had a delay in referral execution. The predictors of delay included age >35 years (odds ratio = 2.45, 95% confidence interval: 1.09-5.50), closed fractures/dislocation (odds ratio = 16.37, 95% confidence interval: 3.13-85.78), admission to surgical wards (odds ratio = 10.25, 95% confidence interval: 2.70-38.82), and a duration ≥7 days from admission to referral recommendation (odds ratio = 4.80, 95% confidence interval: 1.38-16.63). CONCLUSION: Over 50% of referrals were completed in a timely fashion due to a strong referral system and a patient support program. Empowering district hospitals with trained staff and appropriate equipment could reduce the need for referral, and increasing surgeons at referral hospitals could reduce referral delays.
Authors: Kiran J Agarwal-Harding; Linda C Chokotho; Nyengo C Mkandawire; Claude Martin; Elena Losina; Jeffrey N Katz Journal: J Bone Joint Surg Am Date: 2019-05-15 Impact factor: 5.284
Authors: Mohammad Salman Khalil; Asad Latif; Muhammad Nabeel Ashraf; Muhammad Mehmood Alam Atiq; Hasnain Zafar; Adil Haider; Lubna Samad Journal: World J Surg Date: 2021-07-12 Impact factor: 3.352
Authors: Rebecca G Maine; Allison F Linden; Robert Riviello; Emmanuel Kamanzi; Gita N Mody; Georges Ntakiyiruta; Grace Kansayisa; Edmond Ntaganda; Francine Niyonkuru; Joel M Mubiligi; Tharcisse Mpunga; John G Meara; Bethany L Hedt-Gauthier Journal: JAMA Surg Date: 2017-12-20 Impact factor: 14.766
Authors: J Ruhumuriza; J Odhiambo; R Riviello; Y Lin; T Nkurunziza; M Shrime; R Maine; J M Omondi; C Mpirimbanyi; J de la Paix Sebakarane; P Hagugimana; C Rusangwa; B Hedt-Gauthier Journal: BJS Open Date: 2018-02-07
Authors: Maria Lisa Odland; John Whitaker; Dmitri Nepogodiev; Carolyn Achieng' Aling'; Irene Bagahirwa; Theophile Dushime; Darius Erlangga; Christophe Mpirimbanyi; Severien Muneza; Menelas Nkeshimana; Martin Nyundo; Christian Umuhoza; Eric Uwitonze; Jill Steans; Alison Rushton; Antonio Belli; Jean Claude Byiringiro; Abebe Bekele; Justine Davies Journal: World J Surg Date: 2020-09 Impact factor: 3.282