title: Inter-facility transfer of surgical emergencies in a developing country: effects on management and surgical outcomes.
abstract: OBJECTIVE
  Outcomes of surgical emergencies are associated with promptness of the appropriate surgical intervention. However, delayed presentation of surgical patients is common in most developing countries. Delays commonly occur due to transfer of patients between facilities. The aim of the present study was to assess the effect of delays in treatment caused by inter-facility transfers of patients presenting with surgical emergencies as measured by objective and subjective parameters.
  
  
  METHODS
  We prospectively collected data on all patients presenting with an acute surgical emergency at Aga Khan University Hospital (AKUH). Information regarding demographics, social class, reason and number of transfers, and distance traveled were collected. Patients were categorized into two groups, those transferred to AKUH from another facility (transferred) and direct arrivals (non-transfers). Differences between presenting physiological parameters, vital statistics, and management were tested between the two groups by the chi square and t tests.
  
  
  RESULTS
  Ninety-nine patients were included, 49 (49.5 %) patients having been transferred from another facility. The most common reason for transfer was "lack of satisfactory surgical care." There were significant differences in presenting pulse, oxygen saturation, respiratory rate, fluid for resuscitation, glasgow coma scale, and revised trauma score (all p values <0.001) between transferred and non-transferred patients. In 56 patients there was a further delay in admission, and the most common reason was bed availability, followed by financial constraints. Three patients were shifted out of the hospital due to lack of ventilator, and 14 patients left against medical advice due to financial limitations. One patient died.
  
  
  CONCLUSIONS
  Inter-facility transfer of patients with surgical emergencies is common. These patients arrive with deranged physiology which requires complex and prolonged hospital care. Patients who cannot afford treatment are most vulnerable to transfers and delays.
authors.affiliation: Department of Surgery, Memon Medical Institute, Karachi, Pakistan, dr_salmakhan@yahoo.com.
authors.forename: Salma
authors.initials: S
authors.lastname: Khan
authors.forename: Hasnain
authors.initials: H
authors.lastname: Zafar
authors.forename: Syed Nabeel
authors.initials: SN
authors.lastname: Zafar
authors.forename: Naveed
authors.initials: N
authors.lastname: Haroon
mesh_terms: D000328:Adult; D004630:Emergencies; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D010360:Patient Transfer / Q000458:organization & administration*; D011446:Prospective Studies; D013514:Surgical Procedures, Operative