An audit of the referrals to the Chris Hani Baragwanath academic hospital psychiatry outpatients department

Abstract

Aim The aim of this study was to conduct a clinical audit of all new referrals to the Chris Hani Baragwanath Academic Hospital (CHBAH) Psychiatry Outpatients Department (OPD) over a six month period, in order to assess the appropriateness and the quality of these referrals for the level of care provided. Objectives The study objectives were as follows: to describe, in a group of patients referred to CHBAH Psychiatry OPD, their socio-demographic characteristics, the sources of referral, the reasons for the referral, diagnoses and interventions prior to referral, as well as diagnoses, interventions and final outcomes following an assessment by the CHBAH psychiatry outpatients staff. Based on these an assessment of the appropriateness of referral was made. This was a retrospective record review of all consecutive new outpatients referred to the CHBAH Psychiatry OPD for the period of 1 July 2012 to 31 December 2012. The study was conducted at Chris Hani Baragwanath Academic Hospital, which is a tertiary level hospital whose psychiatric department caters for mental health care users in the Southern Metro District Johannesburg area in the province of Gauteng, South Africa. Results The study found that most patients who were referred were female (68.8%), aged 18-39 years (48.9%), unemployed (70.5%), single (47.2%) and had attained a secondary level of education (57.4%). The largest source of referrals was from other disciplines within CHBAH (32.4%), in particular the department of internal medicine (20.5%). The commonest referral reason, referral diagnosis (29%) and diagnosis made by the CHBAH Psychiatry OPD staff was that of depressive disorders (35.8%, 29% and 31.3% respectively). 74.4% of patients did not have investigations done prior to referral; the commonest intervention at Psychiatry OPD was the initiation of psychotropic medication (56.8%) and the commonest outcome was follow-up at Psychiatry OPD (67.6%). Only 14.8% of new referrals were assessed as being appropriate, as 55.7% of patients did not have a diagnosis on referral, the diagnosis on referral was correct in 34.7% of cases, 39.2% of patients had not been initiated on any treatment prior to referral and the majority of patients did not have investigations performed on them prior to referral. Discussion The study provides further evidence that referral pathways are often bypassed, with many patients requiring simple interventions unable to access these at lower levels of care for a variety of reasons. Thus higher levels of care may become overburdened, further impacting on quality of care. Additional resource constrictions may be incurred, which has a ripple effect across all levels of care, often with far-reaching economic consequences. It is evident that the practical implementation of policies is faced with a number of challenges; these need to be addressed in order for the health care system to appropriately perform its function.