Introduction: Referral is the transfer of care for a patient from one clinician to another. Tertiary care is usually done by referral from primary or secondary medical care personnel. Various researches have been done on quality of referral and various factors influencing it i.e. factors related to physician and patient. But there is no significant work on analyzing the quality of consultation for referred patients. Purpose of our study is to evaluate the quality of consultation for the patients being referred from various other health facilities to Surgical outpatient department (OPD) of Bahawal Victoria Hospital (BVH), Bahawalpur.
Objectives:
· To find outcome of level of consultancies to the referred patients from other health facilities.
· To assess the response of healthcare provider to the referred patients from other health facilities. Study Design: It is a “Cross sectional” study.
Study Setting: Surgical outpatient department (OPD) of Bahawal Victoria Hospital, Bahawalpur.
Subjects: All the referred patients from other health care facilities visiting surgical OPD of BVH from 20 April-20 May 2018
Methodology: Subjects were accessed by through non-probability convenient sampling techniques. Subjects were the patients who attended surgical OPD of BVH. Written consent from the patients was obtained after informing them about the purpose of the study survey. Detail structured questionnaire was used to collect data. A face to face interview was conducted. The questionnaire was translated into local language for convenience.
Results: A total of 34 referred patients were interviewed, attending surgical OPD of Bahawal Victoria Hospital, Bahawalpur. 70.6% of patients were referred from within the Bahawalpur city and 29.4% were referred from periphery. The percentage of people having referral note with them was 47.1% and those referred without note was 52.9%. 35.3% of patients were referred from Basic Health Units (BHU). 26.5% from District Head Quarter (DHQ) Hospital. 14.7% from Tehsil Head Quarter (THQ) Hospital. 55.9% were using Hired private transport services. 26.5% were using self-transport. 11.8% using Govt. Transport. 5.9 % used Ambulance. 50% patients acknowledged of having advantage of referral note. Most of the patients (38.2%) were attended by Post Graduate Trainees. 23.5% patients were attended by Medical officer on duty. Among all the patients referred, 20.6% of them were admitted while 79.4% of them received ambulatory services. Chi-Square test was applied to check association between referral note and its advantage with df =1 and p value (0.05) reveals that there is significant association between referral note and its advantage. Out of 16 patients with referral note 12 patients (75%) availed advantage of referral note.
Conclusions:The number of referrals to Surgical OPD of BVH is quite low which is attributed to more number of self referrals and unsatisfactory referral system. Even the patients being referred do not have prescribed referral form and most of the referrals were verbal. But level of consultancy is quite satisfactory for referred patients. Patients with referral note, either prescribed or informal experienced advantage over verbally referred patients. Time delay to approach doctor after issuance of slip is not more than one hour for most of patients. Majority of referred patients are being attended by Senior doctors and in case being attended by House officers it is at least done under supervision of Registrar. Most of the patients received OPD services and did not require admission and disposal is being decided by Registrar or above
