Adherence to national healthcare referral guidelines and its effect on the management outcomes among children seen at a Teaching Hospital in western Kenya

Abstract

Background: 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 to healthcare.
Objective: To determine adherence to the national healthcare referral guidelines and immediate outcomes of children seen at a Moi Teaching and Referral Hospital (MTRH) in Kenya.
Materials and methods: A Cross-sectional study conducted at the Pediatric emergency department of MTRH between February to June 2016 among 422 children aged below 15 years who were recruited systematically. Sociodemographic and clinical data were  collected using interviewer administered questionnaires and clinical chart reviews respectively, while 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.
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 transfer guideline  requirements was observed in 46.3% (n=31) of the 67 hospital referrals. Lower parental level of education (p=0.025), residing outside the host county (p<0.001) and being older than five years (p=0.015) were significantly associated with hospital referrals. There was a nearly three-time likelihood of admission (AOR = 2.932; 95% CI: 2.422 – 3.550; p<0.001) among children referred from hospitals compared to self-referrals.
Conclusion: There is low adherence to national healthcare referral guidelines at Moi Teaching and Referral Hospital.