Orietta Agasaro1, Georgette Munezero2, Rex Wong2,3, Aimé Hirwa4, Abebe Bekele2. 1. University of Global Health Equity, Kigali, PO Box 6955, Kigali, Rwanda. orietta1959l@gmail.com. 2. University of Global Health Equity, Kigali, PO Box 6955, Kigali, Rwanda. 3. School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA. 4. Ruhengeri Hospital, Musanze, Rwanda.
Abstract
BACKGROUND: Surgical interventions are cost-effective methods to save lives and prevent disabilities. Surgical delays and access to three Bellwether procedures are key monitoring indicators for universal access to safe and affordable surgical and anesthesia care and health system performance. This study assessed the delays in receiving surgical and anesthesia care for emergency surgical patients at a district hospital in Northern Rwanda. METHODS: A questionnaire was used to survey all emergency surgical patients who presented at the hospital between May and July 2020, to assess the delays in seeking (first) and reaching (second) care. In-hospital (third) delay and patient outcomes within the first 7 days postsurgery were collected by patient file auditing. Factors associated with third delay were identified through healthcare provider in-depth interviews. RESULTS: A total of 106 patients were surveyed, and nine healthcare providers were interviewed. The median was less than a day for first delay, 1 day for second delay, and 16.5 h for third delay for all emergency procedures. 20% of the Bellwether procedures were performed within two hours after arriving at the hospital. Factors affecting the delays included visiting a traditional healer, district of residence, referral system, income status, as well as shortage of surgeons and specialists, surgical supplies, and operating theaters. CONCLUSION: Further research to study the cause of delays within the referral system is needed. Surgical outreach, equipment, and infrastructure would help to shorten in-hospital delays. Longer-term follow-up studies on patient complications and outcomes due to delay in surgical care are needed.
BACKGROUND: Surgical interventions are cost-effective methods to save lives and prevent disabilities. Surgical delays and access to three Bellwether procedures are key monitoring indicators for universal access to safe and affordable surgical and anesthesia care and health system performance. This study assessed the delays in receiving surgical and anesthesia care for emergency surgical patients at a district hospital in Northern Rwanda. METHODS: A questionnaire was used to survey all emergency surgical patients who presented at the hospital between May and July 2020, to assess the delays in seeking (first) and reaching (second) care. In-hospital (third) delay and patient outcomes within the first 7 days postsurgery were collected by patient file auditing. Factors associated with third delay were identified through healthcare provider in-depth interviews. RESULTS: A total of 106 patients were surveyed, and nine healthcare providers were interviewed. The median was less than a day for first delay, 1 day for second delay, and 16.5 h for third delay for all emergency procedures. 20% of the Bellwether procedures were performed within two hours after arriving at the hospital. Factors affecting the delays included visiting a traditional healer, district of residence, referral system, income status, as well as shortage of surgeons and specialists, surgical supplies, and operating theaters. CONCLUSION: Further research to study the cause of delays within the referral system is needed. Surgical outreach, equipment, and infrastructure would help to shorten in-hospital delays. Longer-term follow-up studies on patient complications and outcomes due to delay in surgical care are needed.
Authors: Luke M Funk; Thomas G Weiser; William R Berry; Stuart R Lipsitz; Alan F Merry; Angela C Enright; Iain H Wilson; Gerald Dziekan; Atul A Gawande Journal: Lancet Date: 2010-07-02 Impact factor: 79.321
Authors: Joseph D Forrester; Jared A Forrester; Thaim B Kamara; Reinou S Groen; Sunil Shrestha; Shailvi Gupta; Patrick Kyamanywa; Robin T Petroze; Adam L Kushner; Sherry M Wren Journal: JAMA Surg Date: 2016-03 Impact factor: 14.766
Authors: Kathleen M O'Neill; Sarah L M Greenberg; Meena Cherian; Rowan D Gillies; Kimberly M Daniels; Nobhojit Roy; Nakul P Raykar; Johanna N Riesel; David Spiegel; David A Watters; Russell L Gruen Journal: World J Surg Date: 2016-11 Impact factor: 3.352