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

IntroductionThis 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.MethodsA 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.ResultsOut 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.DiscussionThe 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.

IntroductionCette etude a ete entreprise pour evaluer l’efficacite du systeme courant de reference, des secteurs ruraux au soin tertiaire,dans le cap occidental de L’Afrique du Sud, et a la perspicacite de gain dans des modeles de tranfert et des resultats patients.MethodesUne etude d’observation retrospective d’un an de toute la priorite une transfere a partir de deux regions rurales a un hopital tertiare au cap. Des modes du transfer utilises ont ete compares. les donnees ont rassembles la demographie patiente incluse, les modeles temporels des tranferts, la distance de transfert, le niveau du soin pendant le transfer, le diagnostic, la disposition et les resultats, et la longueur du sejour d’hopital.ResultatsDehors d’un total de 334 tranferts patients, 64% etaient des males, avec 20% de transferts se produisant un dimanche, et 55% entre 12hr et 20hr. Le trauma a explique 46% de references; les dommages principaux etaient le diagnostic dans 58% de ces patients. Apres admission, 39% de patients a exige la chirurgie et/ou la gestion intensive ou elevee d’unite de soin. 80% de patients ont ete decharges; 20% mort. Les males ont eu un plus long sejour d’hopital,et les patients transportes par aile de rotor sont restes plus longtemps.DiscussionLe systeme occidental du cap SME transfere des nombres significatifs des patients serieusement blesses et malades, dont le plus grand groupe est de jeunes males apres trauma. La formation focalisee, depassent et les services de telemedecine peuvent aider a ameliorer les resultats pour ces patients. Des protocols appropries pour l’usage du rotor et des ressources fixes d’ailes sont exiges,pour aider a assurer des resultats patients et pour faire la meilleure utilisation des ressources limitees.