Adherence to national healthcare referral guidelines and its effect on the management outcomes among children seen at a teaching hospital in Western Kenya.

Abstract

Introduction: Referral guidelines are meant to ensure coordination and continuity across all levels of healthcare. Poor adherence to these guidelines could result in increased morbidity and mortality among the patients who are denied access; especially in the resource constrained healthcare settings in developing economies. Aim: To determine adherence to the national healthcare referral guidelines and immediate outcomes of children seen at a tertiary teaching hospital in Western Kenya. Materials and methods: A Cross-sectional study conducted at the Pediatric emergency department of Moi Teaching and Referral Hospital in Western Kenya between February to June 2016. A total of 422 children aged below 15 years were recruited systematically. Sociodemographic and clinical data were collected using interviewer administered questionnaires and clinical chart reviews respectively. Checklists were used to collect information from ambulances. Pearson chi-square tests and odds ratios were used to test for association between predictor and outcome variables using statistical package for social science (SPSS) version-24.Results: More than half (55.5%) of the 422 children enrolled were male while 51.4% were aged between 5 to 14 years. Hospital referrals accounted for 15.9% (n=67) with the rest being self- referrals and no counter referrals seen. Adherence to all the four transfer guideline requirements was observed in 46.3% (n=31) of the 67 hospital referrals. Less than half (46.3%) of the hospital referrals had their referring facilities calling the receiving facility prior to initiating the referral; 83.6% had a referral document; 64.2% were transferred in ambulances while 68.7% (n=46) were accompanied by health care workers. Most (88.1%) of the hospital referrals were admitted. Lower level of parental education (p= 0.025), residing outside the host county (p<0.001) and a child being older than five years (p = 0.015) were significantly associated with hospital referrals. Hospital referrals were nearly three times (AOR = 2.932; 95% CI: 2.422 – 3.550; p<0.001) more likely to be admitted compared to children who were self-referred. Conclusion: There is low adherence to national healthcare referral guidelines among children seen at the second largest national hospital in Kenya; with less than half of hospital referrals transferred as per the transfer process guidelines.