Evaluating referrals between rural district hospitals and a regional hospital in South Africa
Background: 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 re...
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| Format: | Article |
| Language: | English |
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AOSIS
2025-07-01
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| Series: | African Journal of Primary Health Care & Family Medicine |
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| Online Access: | https://phcfm.org/index.php/phcfm/article/view/4956 |
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| author | Kambola D. Ngoie Louis Jenkins Johann Schoevers |
| author_facet | Kambola D. Ngoie Louis Jenkins Johann Schoevers |
| author_sort | Kambola D. Ngoie |
| collection | DOAJ |
| description | Background: 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).
Aim: This study aimed to evaluate emergency and non-emergency patient referral processes between DHs and the RH in two districts in South Africa.
Setting: Ten DHs and the RH in the Garden Route and Central Karoo districts in South Africa.
Methods: 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.
Results: 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.
Conclusion: 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. |
| format | Article |
| id | doaj-art-a6e42a1a7d924eb1855e4e797a45c862 |
| institution | Kabale University |
| issn | 2071-2928 2071-2936 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | AOSIS |
| record_format | Article |
| series | African Journal of Primary Health Care & Family Medicine |
| spelling | doaj-art-a6e42a1a7d924eb1855e4e797a45c8622025-08-20T03:42:53ZengAOSISAfrican Journal of Primary Health Care & Family Medicine2071-29282071-29362025-07-01171e1e1110.4102/phcfm.v17i1.49561276Evaluating referrals between rural district hospitals and a regional hospital in South AfricaKambola D. Ngoie0Louis Jenkins1Johann Schoevers2Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape TownDepartment of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; and, Primary Health Care Directorate, Family, Community and Emergency Care, Faculty of Medicine and Health Sciences, University of Cape Town, Cape Town, South Africa; and, Department of Family and Emergency Medicine, George Hospital, Western Cape Department of Health, GeorgeDepartment of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape TownBackground: 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). Aim: This study aimed to evaluate emergency and non-emergency patient referral processes between DHs and the RH in two districts in South Africa. Setting: Ten DHs and the RH in the Garden Route and Central Karoo districts in South Africa. Methods: 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. Results: 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. Conclusion: 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.https://phcfm.org/index.php/phcfm/article/view/4956referralsdistrict hospitalsregional hospitalrural districtssouth africa |
| spellingShingle | Kambola D. Ngoie Louis Jenkins Johann Schoevers Evaluating referrals between rural district hospitals and a regional hospital in South Africa African Journal of Primary Health Care & Family Medicine referrals district hospitals regional hospital rural districts south africa |
| title | Evaluating referrals between rural district hospitals and a regional hospital in South Africa |
| title_full | Evaluating referrals between rural district hospitals and a regional hospital in South Africa |
| title_fullStr | Evaluating referrals between rural district hospitals and a regional hospital in South Africa |
| title_full_unstemmed | Evaluating referrals between rural district hospitals and a regional hospital in South Africa |
| title_short | Evaluating referrals between rural district hospitals and a regional hospital in South Africa |
| title_sort | evaluating referrals between rural district hospitals and a regional hospital in south africa |
| topic | referrals district hospitals regional hospital rural districts south africa |
| url | https://phcfm.org/index.php/phcfm/article/view/4956 |
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