Surgical referrals in Northern Tanzania: a prospective assessment of rates, preventability, reasons and patterns

• DOI: 10.1186/s12913-020-05559-x
• Publication Date: 2020-08-08T08:03:36Z
• Authors: Desmond T. Jumbam; Gopal Menon; Tenzing N. Lama; William Lodge II; Sarah Maongezi; Ntuli A. Kapologwe; Isabelle Citron; David Barash; John Varallo; Erin Barringer; Monica Cainer; Mpoki Ulisubisya; Shehnaz Alidina; Boniface Nguhuni
• Keywords: Health administration; Health Services Research; Tertiary referral hospital

Abstract Background An effective referral system is essential for a high-quality health that provides safe surgical care while optimizing patient outcomes and ensuring efficiency. The role of systems in countries with under-resourced poorly understood. aim this study was to examine the rates, preventability, reasons patterns outward referrals patients across three levels healthcare Northern Tanzania. Methods Referrals from obstetric wards were assessed at 20 facilities five rural regions prospectively over 3 months. Trained physician data collectors used collection forms capture details daily hospital letters through discussions clinicians nurses. deemed preventable if presenting condition one should be managed referring facility level per national surgical, anaesthesia plan but referred. Results Seven hundred forty-three total recorded during period. rate highest regional hospitals (2.9%), followed by district (1.9%) centers (1.5%). About 35% all preventable, (70%). most common staff-related (76%), equipment (55%) drugs or supplies (21%). Patient preference accounted 1% referrals. Three quarters (77%) zonal hospital, (17%) (12%). reason (84%) (66%) need specialist non-functional imaging diagnostic (28%). Conclusions Improving Tanzania, order improve quality efficiency care, will require significant investments human resources meet recommended standards each care. Specifically, improving access specialists likely reduce number higher hospitals, thereby reducing overcrowding higher-level system.