title: Obstetric referrals from a rural clinic to a community hospital in Honduras.
abstract: OBJECTIVE
  referrals between health care facilities are important in low-resource settings, particularly in maternal and child health, to transfer pregnant patients to the appropriate level of obstetric care. Our aim was to characterise the obstetrical referrals from a rural clinic to a community referral hospital in Honduras, to identify barriers in effective transport/referral, and to describe subsequent patient outcomes.
  
  
  METHODS
  we performed a descriptive retrospective study of patients referred during a 9-month period. We reviewed patient charts to review diagnosis, referral, and treatment times at both sites to understand the continuity of care.
  
  
  RESULTS
  ninety-two pregnant patients were referred from the rural clinic to the community hospital. Twenty six pregnant patients (28%) did not have complete and accurate medical records and were excluded from the study. The remaining 66 patients were our study population. Of the 66 patients, 54 (82%) received antenatal care with an average of 5.5±2.4 visits. The most common diagnoses requiring referral were non-reassuring fetal status, hypertensive disorders of pregnancy, and preterm labour. The time spent in the rural clinic until transfer was 7.35±8.60 hours, and transport times were 4.42±1.07 hours. Of the 66 women transferred, 24 (36%) had different primary diagnoses and 16 (24%) had additional diagnoses after evaluation in the community hospital, whereas the remaining 26 (40%) had diagnoses that remained the same. No system was in place to give feedback to the referring clinic doctors regarding their primary diagnoses.
  
  
  CONCLUSIONS
  our results demonstrate challenges seen in obstetric transport from a rural clinic to a community hospital in Honduras. Further research is needed for reform of emergency obstetric care management, targeting both healthcare personnel and medical referral infrastructure. The example of Honduras can be taken to motivate change in other resource-limited areas.
authors.affiliation: The Ohio State University College of Medicine, Columbus, OH, USA. Electronic address: srirama.josyula@gmail.com.
authors.forename: Srirama
authors.initials: S
authors.lastname: Josyula
authors.affiliation: Harvard Medical School, Cambridge, MS, USA.
authors.forename: Kathryn K
authors.initials: KK
authors.lastname: Taylor
authors.affiliation: Radiation Medicine, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Blair M
authors.initials: BM
authors.lastname: Murphy
authors.affiliation: Shoulder to Shoulder, Santa Lucía, Honduras.
authors.forename: Dairamise
authors.initials: D
authors.lastname: Rodas
authors.affiliation: Perinatal Institute, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH, USA; Global Health Center, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Beena D
authors.initials: BD
authors.lastname: Kamath-Rayne
mesh_terms: D003266:Continuity of Patient Care; D003695:Delivery of Health Care; D003906:Developing Countries; D005260:Female; D006721:Honduras / Q000453:epidemiology; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D000068101:Maternal-Child Health Services / Q000592:standards / Q000706:statistics & numerical data*; D010360:Patient Transfer; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000628:therapy; D011295:Prenatal Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data / Q000600:supply & distribution*
keywords: Basic emergency obstetrical care; Low-resource settings; Obstetrical transport