Benefits to a regional neurosurgical unit following the introduction of a decentralised imaging facility
Nadvi, S.S.; Parboosing, R.; van Dellen, J.R.
South African Medical Journal 87(12): 1669-1671
1997
ISSN/ISBN: 0256-9574 PMID: 9497831 Document Number: 470679
To determine whether the establishment of a peripheral computed tomography (CT) facility has an influence on the central referral neurosurgical unit, and particularly whether unnecessary referrals are avoided. The outpatient records of all patients referred from Umtata General Hospital (UGH) to the neurosurgical unit at Wentworth Hospital, Durban, were retrospectively analysed over a 4-year period--2 years before and 2 after the introduction of CT facilities at UGH. Wentworth Hospital, Durban, which houses the sole neurosurgical referral centre for the region. Eight hundred and forty patients were referred to the neurosurgical unit from UGH during the 4-year study period--July 1990 to June 1994. 1. The number of referrals to the neurosurgical unit before and after introduction of peripheral CT facilities at UGH. 2. The admission rate of the above referrals during the same periods, indicating appropriate referrals. 1. There were 536 patients referred from UGH to the neurosurgical unit over a 2-year period before the introduction of peripheral CT facilities, and 304 patients during the subsequent 2-year period after introduction of CT facilities at UGH. This represented a 43.3% decrease in patient referrals during a period in which referrals from all other areas increased by 2.6%. 2. The admission rate of patients (indicating appropriate referrals) being referred from UGH increased from 46.3% before CT facilities to 79.9% after the introduction of peripheral CT facilities. The admission rate of patients from other areas, excluding UGH, during the same periods, decreased from 50.3% to 46.4%. This audit reveals that following the introduction of CT facilities at UGH, the number of referrals to Wentworth Hospital's neurosurgical unit decreased by almost half (43.3%). Furthermore, the patients referred after introduction of the peripheral CT facility were more likely to be appropriate referrals (79.9%) than before (46.4%). Therefore, the provision of CT facilities at peripheral hospitals may effectively serve to exclude those patients who would otherwise be referred unnecessarily, and enable earlier referral of those patients who require urgent care at a tertiary neurosurgical unit.