University Library
  • Login
A gateway to Melbourne's research publications
Minerva Access is the University's Institutional Repository. It aims to collect, preserve, and showcase the intellectual output of staff and students of the University of Melbourne for a global audience.
View Item 
  • Minerva Access
  • Medicine, Dentistry & Health Sciences
  • Melbourne Medical School
  • Surgery (St Vincent's)
  • Surgery (St Vincent's) - Research Publications
  • View Item
  • Minerva Access
  • Medicine, Dentistry & Health Sciences
  • Melbourne Medical School
  • Surgery (St Vincent's)
  • Surgery (St Vincent's) - Research Publications
  • View Item
JavaScript is disabled for your browser. Some features of this site may not work without it.

    Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal

    Thumbnail
    Download
    Published version (565.7Kb)

    Citations
    Scopus
    Web of Science
    Altmetric
    3
    3
    Author
    Fleming, M; King, C; Rajeev, S; Baruwal, A; Schwarz, D; Schwarz, R; Khadka, N; Pande, S; Khanal, S; Acharya, B; ...
    Date
    2017-09-25
    Source Title
    BMC Health Services Research
    Publisher
    BIOMED CENTRAL LTD
    University of Melbourne Author/s
    Gyorki, David
    Affiliation
    Surgery (St Vincent's)
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Fleming, M., King, C., Rajeev, S., Baruwal, A., Schwarz, D., Schwarz, R., Khadka, N., Pande, S., Khanal, S., Acharya, B., Benton, A., Rogers, S. O., Panizales, M., Gyorki, D., McGee, H., Shaye, D. & Maru, D. (2017). Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal. BMC HEALTH SERVICES RESEARCH, 17 (1), https://doi.org/10.1186/s12913-017-2624-2.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/255111
    DOI
    10.1186/s12913-017-2624-2
    Abstract
    BACKGROUND: Patients in isolated rural communities typically lack access to surgical care. It is not feasible for most rural first-level hospitals to provide a full suite of surgical specialty services. Comprehensive surgical care thus depends on referral systems. There is minimal literature, however, on the functioning of such systems. METHODS: We undertook a prospective case study of the referral and care coordination process for cardiac, orthopedic, plastic, gynecologic, and general surgical conditions at a district hospital in rural Nepal from 2012 to 2014. We assessed the referral process using the World Health Organization's Health Systems Framework. RESULTS: We followed the initial 292 patients referred for surgical services in the program. 152 patients (52%) received surgery and four (1%) suffered a complication (three deaths and one patient reported complication). The three most common types of surgery performed were: orthopedics (43%), general (32%), and plastics (10%). The average direct and indirect cost per patient referred, including food, transportation, lodging, medications, diagnostic examinations, treatments, and human resources was US$840, which was over 1.5 times the local district's per capita income. We identified and mapped challenges according to the World Health Organization's Health Systems Framework. Given the requirement of intensive human capital, poor quality control of surgical services, and the overall costs of the program, hospital leadership decided to terminate the referral coordination program and continue to build local surgical capacity. CONCLUSION: The results of our case study provide some context into the challenges of rural surgical referral systems. The high relative costs to the system and challenges in accountability rendered the program untenable for the implementing organization.

    Export Reference in RIS Format     

    Endnote

    • Click on "Export Reference in RIS Format" and choose "open with... Endnote".

    Refworks

    • Click on "Export Reference in RIS Format". Login to Refworks, go to References => Import References


    Collections
    • Minerva Elements Records [45770]
    • Surgery (St Vincent's) - Research Publications [324]
    Minerva AccessDepositing Your Work (for University of Melbourne Staff and Students)NewsFAQs

    BrowseCommunities & CollectionsBy Issue DateAuthorsTitlesSubjectsThis CollectionBy Issue DateAuthorsTitlesSubjects
    My AccountLoginRegister
    StatisticsMost Popular ItemsStatistics by CountryMost Popular Authors