title: Consultations at central hospitals: reasons and outcome of referrals from urban clinics in Bulawayo, Zimbabwe.
abstract: OBJECTIVE
  To quantify the main reasons for referral from urban primary health care clinics to central hospitals and to assess the outcome of such referrals in Bulawayo.
  
  
  METHODS
  Descriptive cross sectional study.
  
  
  METHODS
  Mpilo Central Hospital, a quaternary level hospital and referral centre for urban clinics.
  
  
  METHODS
  914 patients referred by urban clinics who attended the hospital in April and May 1995.
  
  
  METHODS
  Frequency of referrals by referrer, reasons for referral, outcome of referrals, diagnosis of admitted referrals.
  
  
  RESULTS
  Of 914 referrals studied, 863 (94%) were made by registered general nurses and 51 (6%) by medical officers. Four hundred and forty four (49%) referrals made by registered general nurses were for doctors to establish the diagnosis, and 341 (37%) were for treatment or operation. The other referrals were for specialists to take over management, for advice on management and referral back to the clinic, and for the hospital to carry out specific tests. Of all referrals, 844 (92%) were consulted by generalist medical officers (GMOs), and only 70 (8%) by specialists. A total of 148 (16%) patients were admitted. Of these, 84 (57%) were females and 47% of admissions were aged 15 years or more. Nine (18%) of 51 referrals made by medical officers were admitted compared to 139 (16%) of 863 by registered general nurses. The rate of admission was not different by referrer (p = 0.7).
  
  
  CONCLUSIONS
  The main reasons for referral from urban clinics to central hospitals are for doctors to either establish the diagnosis or provide treatment. There is scope for reducing the number of referrals made primarily for these reasons if a secondary or tertiary level of care institution is availed to Bulawayo and/or if clinic operations are reorganized to make medical officers' advice more accessible to registered general nurses during working hours.
authors.affiliation: Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: M
authors.initials: M
authors.lastname: Tshimanga
authors.forename: R A
authors.initials: RA
authors.lastname: Dlodlo
authors.forename: T
authors.initials: T
authors.lastname: Marufu
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D019037:Urban Health Services / Q000706:statistics & numerical data*; D015030:Zimbabwe