Information use in patients' referral system at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Implementation of a functional and well managed referral system leads to good health care quality. Referral systems face many challenges for effective functioning as a result of improper documentation of referral letters, poor feedback, and insufficient supply of referral slips and lack of communication.

The objective of this study was to assess information use in patient's referral system, current referral process, and problems associated with documentation at TASH.

A total of 1600 consecutive referral papers of two months, September and October 2009, were assessed for documentation of, socio-economic characteristics of patient, date of referral, clinicall variables, major reason for referral, the status and name of referring health professional, the presence and absence of feedback slip based on the standard proposed by the Federal Ministry of Health. Exit interview was conducted on 385 respondents using structured questionnaire. In-depth interview was also done with 12 physicians and administrative staff on the use of referral papers.

The findings on referral slips indicated that substandard formats ranged from those missing names (0.1%) to missing space for recording the time of referral (62.4%). Chief complaints of patients were documented in 991 (61.9%) of the papers, not documented in 31 (1.9%) referral papers while the rest 578 (36.1%) didn't have the variable on the slip. Clinical findings of patients were written on 1383 (86.4%) collected papers; there was no documentation in 159 (9.9%). Concerning the type of treatment given, 627 (39.2%) papers have documentations, 238 (14.9%) documented that treatment was 'not given' and in 675 (42.2%) papers there was no documentation at all, and the variable did not exist in 60 (3.8%) referral papers.

There is poor referral documentation, information use and feedback mechanisms by the health professionals. There is no operational guideline and proper monitoring system that helps for enhanced information provision and utilization process in general.