Background Patient referral is a process in which a healthcare provider decides to seek assistance due to the limitations of available skills, resources and services offered locally. Paper-based referrals predominantly used in low-income countries hardly follow any procedure. This causes a major gap in communication, coordination, and continuity of care between primary and specialized levels, leading to poor access, delay, duplication and unnecessary costs. The goal of this study is to assess the formats and completeness of existing paper-based referral letters in order to improve health information exchange, coordination, and continuity of care. Methods A retrospective exploratory research was conducted in eight public and three private healthcare facilities in the city of Kigali from May to October 2021. A purposive sampling method was used to select hospitals and referral letters from patients’ files. A data capture sheet was designed according to the contents of the referral letters and the resulting responses were analyzed descriptively. Results In public hospitals, five types of updated referral letters were available, in total agreement with World Health Organization (WHO) standards of which two (neonatal transfer form and patient monitoring transfer form) were not used. There was also one old format that was used by most hospitals and another format designed and used by a district hospital (DH) separately. Three formats were designed and used by private hospitals (PH) individually. A total of 2,304 referral letters were perused and the results show that “external transfer” forms were completed at 58.8%; “antenatal, delivery, and postnatal external transfer” forms at 47.5%; “internal transfer” forms at 46.6%; “Referral/counter referral” forms at 46.0%; district hospital referrals (DH2) at 73.4%. Referrals by private hospitals (PH1, PH2 and PH3) were completed at 97.7%, 70.7%, and 0.0% respectively. The major completeness deficit was observed in counter referral information for all hospitals. Conclusion We observed inconsistencies in the format of the available referral letters used by public hospitals, moreover some of them were incompatible with WHO standards. Additionally, there were deficits in the completeness of all types of paper-based referral letters in use. There is a need for standardization and to disseminate the national patient referral guideline in public hospitals with emphasis on referral feedback, referral registry, triage, archiving and a need for regular training in all organizations.
Background Referral systems support the mobility of patients to ensure they receive adequate healthcare services from the appropriate provider. The major triggers for referrals are limited resources and skills at the lower level of care. An electronic referral system has the potential to considerably improve communication between primary care providers and specialists by submitting standardized and complete electronic referral requests which contain all relevant information needed for a smooth coordination, continuity of care, and facilitating urgent cases. The main objective of this study is to investigate the perception of healthcare providers regarding the existing paper-based referrals and their suggestions on the development of the electronic referral system in order to improve the health information exchange, the coordination and the continuity of care. Methods A mixed method approach was used to examine healthcare providers' perception of the referral system. For the quantitative analysis, a questionnaire was used to collect data from July to October 2021. A purposive sampling was used to select healthcare providers and a descriptive analysis was performed using SPSS 27. For the qualitative study design two focused group discussions were conducted, data were transcribed and analyzed using NVivo R 1.6. Results Overall, 345 referral constituents, including 202 mandatory and 143 optional ones were confirmed by the healthcare providers. The qualitative findings concerned two themes. The first one elucidated the challenges with the existing paper-based referral system pointing out delays in the referral process; incompleteness of paper-based referral sheet; referral triage; premature referral; absence or incomplete counter referral; patient privacy; and language problems. The second theme suggested features to be included in the electronic referral system, the procedures to follow during the transition phase, proposed mandatory and optional constituents, predicted challenges and expected benefits. Conclusion This study gathered perceptions of healthcare providers on the existing referral system, further elucidated their expectations on the electronic referral system and proposed features to be considered in its design. Finally, leads to a proposed design of an electronic external referral form.
Background Patient referral is a process in which a healthcare provider decides to seek assistance at a higher level of care. Paper-based referrals predominantly used in low-income countries hardly follow any procedures. This causes a major gap in communication, coordination, and continuity of care between primary and specialized levels, leading to poor access, delay, duplication and unnecessary costs. The goal of this study is to assess the formats and completeness of existing paper-based referral letters to improve health information exchange, coordination, and continuity of care for the hospitals in the urban environment of Kigali. Methods A retrospective exploratory research was conducted in eight public and three private healthcare facilities in the city of Kigali from July 2019 to July 2021. A purposive sampling method was used to select referral letters from patients’ files. A data capture sheet was designed according to the contents of the referral letters and were analyzed descriptively. Results In public hospitals, there were five updated referral letters in total agreement with world health organization (WHO) standards of which two (neonatal transfer form and patient monitoring transfer form) were not used. There was also one old format that was used by most hospitals and another format designed and used by a district hospital (DH) separately. Three formats were designed and used by private hospitals (PH) individually. A total of 2,304 referral letters were perused and the results show that “external transfer” forms were completed at 58,8%; “antenatal, delivery, and postnatal external transfer” forms at 47,5%; “internal transfer” forms at 46,6%; “Fiche de référence / Contre reference” forms at 46,0%; district hospital (DH2) at 73,4%. Referrals by private hospitals (PH1, PH2 and PH3) were completed at 97,7%, 70,7%, and 0.0% respectively. Conclusions There were inconsistencies in the format of the available referral letters used by public hospitals though some of them were incompatible with WHO standards. Additionally, there were deficits in the completeness of referral letters. There is a need to disseminate the national patient referral guideline in public hospitals with emphasis on referral feedback, referral registry, triage, archiving, and regular training organization.
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