An audit of error associated with the initial management and referral of acute trauma patients in Western KwaZulu-Natal.
Trauma centers (Management)
Trauma centers (Services)
Medical errors (Management)
Medical referral (Research)
|Publication:||Name: South African Journal of Surgery Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 South African Medical Association ISSN: 0038-2361|
|Issue:||Date: April, 2011 Source Volume: 49 Source Issue: 2|
|Topic:||Event Code: 200 Management dynamics; 360 Services information; 310 Science & research Canadian Subject Form: Trauma centres; Trauma centres Computer Subject: Company business management|
|Geographic:||Geographic Scope: South Africa Geographic Code: 6SOUT South Africa|
Introduction: Western KZN is a large area with approximately 3
million people. Many of these patients live in remote areas. In the
event of sustaining major trauma, these patients will be treated at a
clinic or district hospital. The periphery is plagued with chronic
under-staffing and high staff turnover, resulting in trauma care of an
extremely uneven quality.
Methodology: We have maintained a database of all trauma referrals from the periphery to our tertiary service in Pietermaritzburg. We have classified all inappropriate and problematic referrals according to four criteria. These are assessment problems, resuscitation problems, logistical problems and operative problems. Assessment problems are errors of planning. Resuscitation problems, operative problems and logistical problems are errors of execution
Results: Over the period July 2009 - June 2010 we received 756 trauma referrals from the periphery. There were 65 (9%) problematic referrals in this period. Of these problematic referrals there were 12 female patients and 1 9-month-old child; the rest were adult males. The average age was 34 years. Blunt trauma was a problem in 40 patients. There were 7 GSW victims, 17 stab victims and 1 burn victim. There were 43 assessment problems, 9 resuscitation problems, 7 logistical problems and 6 operative problems. There were 11 (16%) deaths. Three patients required amputation because of failure to recognise a vascular injury. Renal failure developed in 3 patients due to inadequate resuscitation. Two patients were transferred with untreated pneumothorax. Both developed a tension pneumothorax and 1 died. Cervical spine injuries were not recognised in 2 patients. Delay in diagnosing peritonitis was a problem in 14 patients.
Conclusion: There are significant deficits in trauma care in our referring hospitals. These translate into significant morbidity and mortality. Inadequate assessment and understanding of the pathology being treated is a major problem. Planning errors are more common than execution errors. This has implications for how we teach trauma care in the periphery.
J Howlett, D Clarke, S Thomson
University of KwaZulu-Natal, Pietermaritzburg
|Gale Copyright:||Copyright 2011 Gale, Cengage Learning. All rights reserved.|