Abstract:
Objective To assess the completeness of obstetric referral
letters/notes at the district level of healthcare.
Design An implementation research within three districts
in Greater Accra region using mixed methods. During
baseline and intervention phases, referral processes
for all obstetric referrals from lower level facilities seen
at the district hospitals were documented including
indications for referrals, availability and completeness of
referral notes/forms. An assessment of before and after
intervention availability and completeness of referral
forms was carried out. Focus group discussions, nonparticipant
observations and in-depth interviews with
health workers and pregnant women were conducted for
qualitative data.
Setting Three (3) districts in the Greater Accra region of
Ghana.
Participants Pregnant women referred from lower levels
of care to and seen at the district hospital, health workers
within the three districts and pregnant women attending
antenatal clinic in the district and their family members or
spouses.
Intervention An enhanced interfacility referral
communication system consisting of training, provision
of communication tools for facilities, formation of
hospital referral teams and strengthening feedback
mechanisms.
Outcome Completeness of obstetric referral letters/notes.
Results Proportion of obstetric referrals with referral
notes improved from 27.2% to 44.3% from the baseline
to intervention period. Mean completeness (95% CI) of all
forms was 71.3% (64.1% to 78.5%) for the study period,
improving from 70.7% (60.4% to 80.9%) to 71.9% (61.1%
to 82.7%) from baseline to intervention periods. Health
workers reported they do not always provide referral notes
and that most referral notes are not completely filled due
to various reasons.
Conclusions Most obstetric referrals did not have referral
notes. The few notes provided were not completely filled.
Interventions such as training of health workers, regular
review of referral processes and use of electronic records
can help improve both the provision of and completeness
of the referral notes.