title: Patient transfer practices by hospitals in Western Kenya.
abstract: BACKGROUND
  Patients who are critically ill and those requiring emergency care are transported within and between hospitals on a regular basis seeking diagnostic or therapeutic services not available at the bed side or within the referring institution. The emergency of specialty systems often determines the ultimate destination of patients rather than proximity of facility and this has heightened the need for patient transfer. To achieve a favorable outcome, it is necessary to ensure that any transfer is carried out safely and effectively with minimum disruption of the continuum of care.
  
  
  OBJECTIVE
  To determine the gap between existing knowledge of patient transfer principles and the practice by hospitals in Western Kenya referring patients to Moi Teaching and Referral Hospital (MTRH).
  
  
  METHODS
  Cross-sectional descriptive study.
  
  
  METHODS
  Accident and emergency department at MTRH.
  
  
  METHODS
  Patients transferred in over a period of six months for critical/emergency care.
  
  
  RESULTS
  Evaluation was done for 97 transfers during the six months period. Age ranged from four days old to 70 years with a median of 28 years. A wide spectrum of diseases were seen. However in order of frequency the leading five were; trauma and accidents, vascular disorders, infections; anaemia and malignancies. Of the infections, respiratory infections topped the list with pulmonary tuberculosis as the leading disease entity. Majority of patients 43 (44%) were referred within 24 hours of being seen at the primary hospital. Only 56% were transported by ambulance; appropriate escort(nurse) was provided in 60%; documentation was provided in 85%; monitoring enroute was done in 24%; warmth was provided in 62%, 27% were dehydrated requiring resuscitation; respiratory support was inadequate as only 14% (of those who required) had airway and 32% had oxygen provided; intravenous fluids were provided in 34% of those who required; nasogastric intubation was provided in 30% of those who required; urethral catheterisation was provided in 23% of those who required; 50% of those with long bone fractures were splinted and only 3% of those who required cervical spine stabilisation had cervical collar.
  
  
  CONCLUSIONS
  There was significant failure by hospitals in Western Kenya in the application of principles of patient transfer while referring patients to MTRH.
authors.affiliation: Department of Surgery and Anaesthesiology, Moi University, School of Medicine, P. O. Box 4606 - 30100, Eldoret, Kenya.
authors.forename: R T
authors.initials: RT
authors.lastname: Kuremu
authors.forename: C N
authors.initials: CN
authors.lastname: Tenge
authors.forename: G G
authors.initials: GG
authors.lastname: Wakuloba
authors.forename: A
authors.initials: A
authors.lastname: Wambati
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D005791:Patient Care; D010360:Patient Transfer / Q000379:methods* / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D055815:Young Adult