Indications for referrals to Chris Hani Baragwanath academic hospital gynaecological outpatients department
Date
2016-10-17
Authors
Rockson, Esther
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Abstract
Introduction
Chis Hani Baragwanath Academic Hospital (CHBAH) is a tertiary (level 3) hospital located
in Soweto, Johannesburg. There is no currently no fully functioning district hospital in
Soweto. The CHBAH Gynaecological Outpatients Department (GOPD) is burdened by large
numbers of patients with a case mix from all levels of care.
Objective
To describe the clinical characteristics of patients referred to Chris Hani Baragwanath
Academic Hospital Gynaecological Outpatients Department and classify them according to
levels of care, to assess the lower level case burden carried by the hospital.
Methods
A prospective cross sectional study was conducted over one week, and 200 participants were
selected from the GOPD queue. The researcher interviewed each participant and studied their
records to determine their demographic data, reasons for referral and presenting complaints.
Upon the participant being seen by the on duty doctor, a provisional diagnosis was made and
the appropriate level of care (clinic, level 1 hospital, level 2 hospital, level 3 hospital) was
assigned to each based on predetermined classifications of gynaecological conditions into
their most suitable levels of care.
Results
One hundred and ninety three (96.5%) of the participants were referred, and seven (3.5%)
were brought by paramedics in ambulances. The most common reason for referral was lower
abdominal pain and or vaginal bleeding in pregnancy (n=60; 30%), and the majority of these
patients were treated for miscarriages (n=34; 57%). Twenty-four (12%) required admission to
hospital. The bulk of patients were classified as level 1 (n=89; 44.5%), with 51 (25.5%) being
level 2 and 50 (25%) being level 3 patients. Ten (5.0%) were considered to be primary
healthcare (clinic) patients based on their gynaecological conditions.
Conclusion
The study found that the referral system around Soweto is in place and utilized appropriately
and the majority of patients were referred. The study further found that CHBAH serves
largely as a district hospital for the surrounding clinics. A fully functioning district hospital
would likely relieve CHBAH of much of its burden of patients in the GOPD.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Obstetrics and Gynaecology
Johannesburg, October 2015