Ngoie Kambola D, Jenkins Louis, Schoevers Johann
Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
Afr J Prim Health Care Fam Med. 2025 Jul 9;17(1):e1-e11. doi: 10.4102/phcfm.v17i1.4956.
Efficient referral systems are essential for improving healthcare and patient outcomes, especially in resource-limited settings where access to public specialist care is limited by too few specialists, growing populations and constrained resources impacting non-emergency and emergency referrals. District hospitals (DHs) must ensure that patients receive the appropriate level of care. High-quality referral systems are necessary for the cost-effective flow of patients between district and regional hospitals (RHs).
This study aimed to evaluate emergency and non-emergency patient referral processes between DHs and the RH in two districts in South Africa.
Ten DHs and the RH in the Garden Route and Central Karoo districts in South Africa.
A mixed-methods design incorporated quantitative survey data and qualitative thematic analysis to provide a comprehensive understanding of referral processes. The study population included all doctors working at 10 DHs and the RH, with 120 voluntary participants.
Key findings revealed disparities in referral satisfaction between emergency (66%) and non-emergency (59%) referrals. Communication breakdowns and systemic barriers hindered timely access to specialist care, mismatched expectations and understanding, coupled with inconsistent referral guidelines. Inadequate capacity building increased inappropriate referrals.
Communication breakdowns and differing expectations between DHs and the RH regarding available resources and services negatively impacted referrals. Improved communication, targeted outreach, capacity-building initiatives, stronger collaborative relationships and standardisation of processes could enhance patient referral efficiency.Contribution: This work adds new knowledge to patient referrals between rural district and regional hospitals in resource-limited contexts, highlighting the complexity of the referral process.
高效的转诊系统对于改善医疗保健和患者治疗效果至关重要，尤其是在资源有限的环境中，公共专科护理的可及性受到专科医生数量过少、人口增长以及影响非紧急和紧急转诊的资源受限的限制。地区医院（DHs）必须确保患者获得适当水平的护理。高质量的转诊系统对于患者在地区医院和区域医院（RHs）之间的经济高效流动是必要的。
本研究旨在评估南非两个地区的地区医院和区域医院之间的紧急和非紧急患者转诊流程。
南非花园大道和中央卡鲁地区的10家地区医院和区域医院。
采用混合方法设计，结合定量调查数据和定性主题分析，以全面了解转诊流程。研究人群包括在10家地区医院和区域医院工作的所有医生，共有120名自愿参与者。
主要发现显示，紧急转诊（66%）和非紧急转诊（59%）的转诊满意度存在差异。沟通中断和系统障碍阻碍了及时获得专科护理，期望和理解不匹配，以及转诊指南不一致。能力建设不足增加了不适当的转诊。
地区医院和区域医院在可用资源和服务方面的沟通中断和不同期望对转诊产生了负面影响。改善沟通、有针对性的外展、能力建设举措、更强的合作关系和流程标准化可以提高患者转诊效率。
这项工作为资源有限环境下农村地区医院和区域医院之间的患者转诊增添了新知识，突出了转诊过程的复杂性。
