Patient transport from rural to tertiary healthcare centres in the Western Cape: Is there room for improvement?

摘要

Introduction This study was conducted to evaluate the effectiveness of the current referral system, from rural areas to tertiary care, in the Western Cape of South Africa, and to gain insight into transfer patterns and patient outcomes. Methods A one year retrospective observational study of all priority one transfers from two rural regions to a tertiary hospital in Cape Town. Modes of transport used were compared. Data collected included patient demographics, temporal patterns of transfers, transfer distance, level of care during transfer, diagnosis, disposition and outcome, and length of hospital stay. Results Out of a total of 334 patient transfers, 64% were males, with 20% of transfers occurring on a Sunday, and 55% between 12:00 and 20:00. Trauma accounted for 46% of referrals; head injury was the diagnosis in 58% of these patients. After admission, 39% of patients required surgery and/or intensive or high care unit management. Eighty percent of patients were discharged; 20% died. Males had a longer hospital stay, and rotor wing transported patients stayed longer. Discussion The Western Cape EMS system is transferring significant numbers of seriously injured and ill patients, the largest group being young males following trauma. Focussed training, outreach and telemedicine services may help to improve the outcome for these patients. Appropriate protocols for the use of rotor and fixed wing resources are required, to help ensure patient outcome and make the best use of limited resources.