Evaluation of inter hospital transfer of patients by ambulances to Muhimbili national hospital in accordance to acceptable international standard guidelines

Abstract

Background: Inter-hospital patient transfer is increasing due to centralization of certain procedures and interventions, centralization of certain expertise and lack of beds at the referring hospitals. Taking this into consideration. The detailed locally acceptable standard guidelines needs to be established so as to decrease the morbidity and mortality at the referring hospitals, during transfer and arrival at the referred hospital. And the implementation of standard guidelines will also improve the outcome of patients referred due to the fact that little has been done regarding establishment of Inter-hospital patient transfer standard guidelines in Tanzania. Guidelines from the Association of Anesthetists of Great Britain and Ireland (AAGBI) format will be used in this study as a questionnaire to evaluate the transfer practices at Muhimbili National Hospital so as to guide in future improvement in patients transfer. A retrospective pilot study has shown that in a day around 100 patients are seen at the Muhimbili Emergency Department and this accounts to approximately 3000 patients a month. There is an average of 20 ambulance referrals per day. Objective: To evaluate the Inter hospital transfer of patients by ambulances to Muhimbili National Hospital, Dar-es-Salaam ,in accordance to acceptable International Standard Guidelines. Methodology: A convenience sampling method was conducted among patients referred to Muhimbili National Hospital through Emergency Medicine Department via ambulance. For the purpose of this study, the time between 4pm to 10pm was designated for data collection. Patients transfer personnel was informed about the study and was reassured on confidentiality of their participation after having agreed to join. Transfer personnel were recruited after having agreed there participation and an informed consent were given to them for signing. This study had focused on evaluating the Inter-hospital transfer of patients from pre-transfer decision and communication ,equipment and drugs availability checking, proper documentation, continuous monitoring in transit management and resuscitation, handover and the transport personnel skills using the acceptable standard guidelines. The data was analyzed using Statistical Package for Social Scientists (SPSS) from IBM SPSS Statistics Version 20 computer program. Data was presented as proportions for categorical variables. Univariate analysis was used for characteristics of research participants which were expressed as categorical and continuous variables. The chi-square testing was used to test for association between independent variables and dependent variable. If the p-value was found to be less than 0.05 then the association was deemed significant. Results: A total of 284 transfer personnel were recruited in this study. There were 128(45.2%) males and 156(54.9%) were females...Most referrals were coming from Amana, Mwananyamala and Temeke hospitals which are within Dar-es-Salaam and the least referrals were from Lindi, Ifakara, Zanzibar, Mbeya and Mtwara regions. The study showed that Senior consultants were involved in transfer decision making by 52% and most transfers 76.5%( on average between stable and unstable patients transferred) were facilitated by nurses. The study also found some poor communication, documentation during transfer processes. Unavailability of well trained personnel involved in transfer and lack of important equipments and drugs during transfer processes were also documented. Conclusion and Recommendation Inter-hospital patient transfer is a very important link in patient care continuity from referring to receiving health facilities. There are many gaps that needs to be fulfilled to ensure that the Inter-hospital transfer process is well attained in terms of safety transfer. Proper care during the transfer process and ensuring good outcome during the whole transfer processes; For this matter standard operating procedures for Inter-hospital patient transfer needs to be established.