Acute Care Referral Systems in Liberia: Transfer and Referral Capabilities in a Low-Income Country

Kim, Jimin; Barreix, María; Babcock, Christine; Bills, Corey B

doi:10.1017/s1049023x1700677x

Cited by 15 publications

(23 citation statements)

References 32 publications

(45 reference statements)

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“… 1 30 In Liberia, pre-referral notification was found to be ineffective due to poorly organized and coordinated referral systems and lack of proper referral documentation and standardization of referral processes. 30 …”

Section: Resultsmentioning

confidence: 99%

“… 52 53 Furthermore, existing prehospital referral systems are poorly organized and lack effective linkages with specialized trauma care facilities and communication/command centers for prompt responses and continuity of care which in turn causes avoidable evacuation delays at prehospital care level. 30 54 Referral documentation and coordination is equally poor; many patients are transferred to the next available health facility irrespective of their capacity to provide required care. 30 Many of these facilities are not equipped to provide the indicative critical care and life-saving interventions.…”

Section: Discussionmentioning

confidence: 99%

“…A study done in Liberia identified lay responder skills gap as a major competence challenge in providing critical rescue care at the prehospital care level. 30 To respond to these gaps, countries such as Uganda and Ethiopia designed training programs targeting lay responders such as vehicle drivers and community volunteers aimed at equipping them with relevant first aid skills. The trainings were reported to improve quality of first aid interventions in Uganda and Ethiopia.…”

Section: Prehospital Care Providersmentioning

confidence: 99%

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Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

Koome

Atela

Thuita

et al. 2020

Trauma Surg Acute Care Open

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BackgroundAfrica accounts forabout 90% of the global trauma burden. Mapping evidence on health systemfactors associated with post-trauma mortality is essential in definingpre-hospital care research priorities and mitigation of the burden. The studyaimed to map and synthesize existing evidence and research gaps on healthsystem factors associated with post-trauma mortality at the pre-hospital carelevel in Africa.MethodsA scoping review of published studies and grey literature was conducted. The search strategy utilized electronic databases comprising of Medline, Google Scholar, Pub-Med, Hinari and Cochrane Library. Screening and extraction of eligible studies was done independently and in duplicate.ResultsA total of 782 study titles and or abstracts were screened. Of these, 32 underwent full text review. Out of the 32, 17 met the inclusion criteria for final review. The majority of studies were literature reviews (24%) and retrospective studies (23%). Retrospective and qualitative studies comprised 6% of the included studies, systematic reviews (6%), cross-sectional studies (17%), Delphi studies (6%), panel reviews (6%) and qualitative studies (12%), systematic reviews (6%), cross-sectional studies (17%), Delphi studies (6%), panel reviews (6%) and qualitative studies (12%). Reported post-trauma mortality ranged from 13% in Ghana to 40% in Nigeria. Reported preventable mortality is as high as 70% in South Africa, 60% in Ghana and 40% in Nigeria. Transport mode is the most studied health system factor (reported in 76% of the papers). Only two studies (12%) included access to pre-hospital care interventions aspects, nine studies (53%) included care providers aspects and three studies (18%) included aspects of referral pathways. The types of transport mode and referral pathway are the only factors significantly associated with post-trauma mortality, though the findings were mixed. None of the included studies reported significant associations between pre-hospital care interventions, care providers and post-trauma mortality.DiscussionAlthough research on health system factors and its influence on post-trauma mortality at the pre-hospital care level in Africa are limited, anecdotal evidence suggests that access to pre-hospital care interventions, the level of provider skills and referral pathways are important determinants of mortality outcomes. The strength of their influence will require well designed studies that could incorporate mixed method approaches. Moreover, similar reviews incorporating other LMICs are also warranted. Key Words: Health System Factors, Emergency Medical Services [EMS], Pre-hospital Care, Post-Trauma mortality, Africa.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Prehospital Care Providersmentioning

confidence: 99%

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Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

Koome

Atela

Thuita

et al. 2020

Trauma Surg Acute Care Open

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“…Second, even after the decision to transfer is made, there is almost no communication with the prehospital providers nor receiving facility, which limits real-time resource informed decision making. [39] Protocols for IFT ought to be regionally specific and synergistic with community, prehospital and healthcare facility integration. Targeted interventions, including protocols for care and referral, enhanced communication between prehospital and health facilities during and after transport, and improved documentation, have been shown to help strengthen health systems in LMICs [40] and may help to mitigate the high rates of death seen in this population.…”

Section: Plos Onementioning

confidence: 99%

Acute respiratory illness among a prospective cohort of pediatric patients using emergency medical services in India: Demographic and prehospital clinical predictors of mortality

et al. 2020

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Background In India, acute respiratory illnesses, including pneumonia, are the leading cause of early childhood death. Emergency medical services are a critical component of India's public health infrastructure; however, literature on the prehospital care of pediatric patients in lowand middle-income countries is minimal. The aim of this study is to describe the demographic and clinical characteristics associated with 30-day mortality among a cohort of pediatric patients transported via ambulance in India with an acute respiratory complaint. Methods Pediatric patients less than 18 years of age using ambulance services in one of seven states in India, with a chief complaint of "shortness of breath", or a "fever" with associated "difficulty breathing" or "cough", were enrolled prospectively. Patients were excluded if evidence of choking, trauma or fire-related injury, patient was absent on ambulance arrival, or refused transport. Primary exposures included demographic, environmental, and clinical indicators, including hypoxemia and respiratory distress. The primary outcome was 7 and 30-day mortality. Multivariable logistic regression, stratified by transport type, was constructed to estimate associations between demographic and clinical predictors of mortality. Results A total of 1443 patients were enrolled during the study period: 981 (68.5%) were transported from the field, and 452 (31.5%) were interfacility transports. Thirty-day response was 83.4% (N = 1222). The median age of all patients was 2 years (IQR: 0.17-10); 93.9% (N = 1347) of patients lived on family incomes below the poverty level; and 54.1% (N = 706) were male. Cumulative mortality at 2, 7, and 30-days was 5.2%, 7.1%, and 7.7%, respectively; with 94 deaths by 30 days. Thirty-day mortality was greatest among those 0-28 days (N = 38,17%);

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“…Low-income country evidence has shown a survival benefit for trauma and obstetrical patients when interfacility transfer is more readily available [17,30,31]. When the entire spectrum of interfacility transfers is considered, including modifying factors of initial prehospital system triage that could potentially circumvent the need for interfacility transfer altogether, or improving the efficiency and effectiveness of appropriate interfacility transfers when needed, the actual cause or effect of second and third delays can be more precisely assessed and addressed.…”

Section: Plos Onementioning

confidence: 99%

Publicly funded interfacility ambulance transfers for surgical and obstetrical conditions: A cross sectional analysis in an urban middle-income country setting

et al. 2020

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Introduction Interfacility transfers may reflect a time delay of definitive surgical care, but few studies have examined the prevalence of interfacility transfers in the urban low- and middle-income (LMIC) setting. The aim of this study was to determine the number of interfacility transfers required for surgical and obstetric conditions in an urban MIC setting to better understand access to definitive surgical care among LMIC patients. Methods A retrospective analysis of public interfacility transfer records was conducted from April 2015 to April 2016 in Cali, Colombia. Data were obtained from the single municipal ambulance agency providing publicly funded ambulance transfers in the city. Interfacility transfers were defined as any patient transfer between two healthcare facilities. We identified the number of transfers for patients with surgical conditions and categorized transfers based on patient ICD-9-CM codes. We compared surgical transfers from public vs. private healthcare facilities by condition type (surgical, obstetric, nonsurgical), transferring physician specialty, and transfer acuity (code blue, emergent, urgent and nonurgent) using logistic regression. Results 31,659 patient transports occurred over the 13-month study period. 22250 (70.2%) of all transfers were interfacility transfers and 7777 (35%) of transfers were for patients with surgical conditions with an additional 2,244 (10.3%) for obstetric conditions. 49% (8660/17675) of interfacility transfers from public hospitals were for surgical and obstetric conditions vs 32% (1466/4580) for private facilities (P<0.001). The most common surgical conditions requiring interfacility transfer were fractures (1,227, 5.4%), appendicitis (913, 4.1%), wounds (871, 3.9%), abdominal pain (818, 3.6%), trauma (652, 2.9%), and acute abdomen (271, 1.2%). Conclusion Surgical and obstetric conditions account for nearly half of all urban interfacility ambulance transfers. The most common reasons for transfer are basic surgical conditions with public healthcare facilities transferring a greater proportion of patient with surgical conditions than private facilities. Timely access to an initial healthcare facility may not be a reliable surrogate of definitive surgical care given the substantial need for interfacility transfers.

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Acute Care Referral Systems in Liberia: Transfer and Referral Capabilities in a Low-Income Country

Cited by 15 publications

References 32 publications

Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

Acute respiratory illness among a prospective cohort of pediatric patients using emergency medical services in India: Demographic and prehospital clinical predictors of mortality

Publicly funded interfacility ambulance transfers for surgical and obstetrical conditions: A cross sectional analysis in an urban middle-income country setting

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