Impact of referral guideline enforcement on orthopedic and trauma admissions at Kenyatta National Teaching and Referral Hospital, Kenya: A pre-post test design
Background: The suboptimal utilization of tertiary health facilities and inadequate management of referral systems in low- and middle-income countries pose challenges to health system administration, characterized by frequent self-referrals and bypassing of lower-tier health facilities. On July 1, 2...
| Main Authors: | , , |
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| Format: | Journal Article |
| Language: | Inglés |
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African Journals Online
2023
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| Subjects: | |
| Online Access: | https://hdl.handle.net/10568/175997 |
| _version_ | 1855534491033927680 |
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| author | Omondi, M.P. Korir, Max Owiti, O.J. |
| author_browse | Korir, Max Omondi, M.P. Owiti, O.J. |
| author_facet | Omondi, M.P. Korir, Max Owiti, O.J. |
| author_sort | Omondi, M.P. |
| collection | Repository of Agricultural Research Outputs (CGSpace) |
| description | Background: The suboptimal utilization of tertiary health facilities and inadequate management of referral systems in low- and middle-income countries pose challenges to health system administration, characterized by frequent self-referrals and bypassing of lower-tier health facilities. On July 1, 2021, Kenyatta National Hospital (KNH) implemented referral guidelines, mandating that all admitted patients be referred from lower-tier health facilities, aligning with the KNH legal statute of 1987. This study aimed to evaluate the impact of enforcing referral guidelines on the spatial distribution of orthopedic and trauma admissions at KNH.
Methodology: A pre-post test study design was employed, reviewing a total of 459 and 446 charts in 2021 before and after the enforcement of referral guidelines. Measures of central tendencies and Chi-squared tests were applied, and density plots were generated using Geographic Information System (QGIS 2.18.19) to illustrate the spatial distribution of admissions.
Results: of KNH admissions, 85.3% and 79.3% originated from Nairobi County and its environs. Admissions were geographically diverse, with a notable concentration from Nairobi County and its environs. Enforcement of referral guidelines led to a significant decrease in admissions from Nairobi County, dropping from 64.3% to 56.9% (p=0.019). Declines were particularly observed in Kamukunji, Embakasi, and Ruaraka sub-counties, serving as the catchment population for Mama Lucy Kibaki Referral Hospital. Conversely, admissions from Kibra and most of Kajiado County were notable. There was a concurrent increase in admissions from other parts of the country (p = 0.003).
Conclusion: Over four-fifths of KNH admissions are from Nairobi County and its environs. The enforcement of referral guidelines resulted in decreased local admissions and an uptick in admissions from other regions in the country. |
| format | Journal Article |
| id | CGSpace175997 |
| institution | CGIAR Consortium |
| language | Inglés |
| publishDate | 2023 |
| publishDateRange | 2023 |
| publishDateSort | 2023 |
| publisher | African Journals Online |
| publisherStr | African Journals Online |
| record_format | dspace |
| spelling | CGSpace1759972025-08-06T08:22:33Z Impact of referral guideline enforcement on orthopedic and trauma admissions at Kenyatta National Teaching and Referral Hospital, Kenya: A pre-post test design Omondi, M.P. Korir, Max Owiti, O.J. health hospitals lesions orthopaedics Background: The suboptimal utilization of tertiary health facilities and inadequate management of referral systems in low- and middle-income countries pose challenges to health system administration, characterized by frequent self-referrals and bypassing of lower-tier health facilities. On July 1, 2021, Kenyatta National Hospital (KNH) implemented referral guidelines, mandating that all admitted patients be referred from lower-tier health facilities, aligning with the KNH legal statute of 1987. This study aimed to evaluate the impact of enforcing referral guidelines on the spatial distribution of orthopedic and trauma admissions at KNH. Methodology: A pre-post test study design was employed, reviewing a total of 459 and 446 charts in 2021 before and after the enforcement of referral guidelines. Measures of central tendencies and Chi-squared tests were applied, and density plots were generated using Geographic Information System (QGIS 2.18.19) to illustrate the spatial distribution of admissions. Results: of KNH admissions, 85.3% and 79.3% originated from Nairobi County and its environs. Admissions were geographically diverse, with a notable concentration from Nairobi County and its environs. Enforcement of referral guidelines led to a significant decrease in admissions from Nairobi County, dropping from 64.3% to 56.9% (p=0.019). Declines were particularly observed in Kamukunji, Embakasi, and Ruaraka sub-counties, serving as the catchment population for Mama Lucy Kibaki Referral Hospital. Conversely, admissions from Kibra and most of Kajiado County were notable. There was a concurrent increase in admissions from other parts of the country (p = 0.003). Conclusion: Over four-fifths of KNH admissions are from Nairobi County and its environs. The enforcement of referral guidelines resulted in decreased local admissions and an uptick in admissions from other regions in the country. 2023-07 2025-08-06T07:48:22Z 2025-08-06T07:48:22Z Journal Article https://hdl.handle.net/10568/175997 en Open Access African Journals Online Omondi, M.P., Kipkemoi, M.K. and Owiti, O.J. 2023. Impact of referral guideline enforcement on orthopedic and trauma admissions at Kenyatta National Teaching and Referral Hospital, Kenya: A pre-post test design. African Journal of Health Sciences 36(4): 375–384. |
| spellingShingle | health hospitals lesions orthopaedics Omondi, M.P. Korir, Max Owiti, O.J. Impact of referral guideline enforcement on orthopedic and trauma admissions at Kenyatta National Teaching and Referral Hospital, Kenya: A pre-post test design |
| title | Impact of referral guideline enforcement on orthopedic and trauma admissions at Kenyatta National Teaching and Referral Hospital, Kenya: A pre-post test design |
| title_full | Impact of referral guideline enforcement on orthopedic and trauma admissions at Kenyatta National Teaching and Referral Hospital, Kenya: A pre-post test design |
| title_fullStr | Impact of referral guideline enforcement on orthopedic and trauma admissions at Kenyatta National Teaching and Referral Hospital, Kenya: A pre-post test design |
| title_full_unstemmed | Impact of referral guideline enforcement on orthopedic and trauma admissions at Kenyatta National Teaching and Referral Hospital, Kenya: A pre-post test design |
| title_short | Impact of referral guideline enforcement on orthopedic and trauma admissions at Kenyatta National Teaching and Referral Hospital, Kenya: A pre-post test design |
| title_sort | impact of referral guideline enforcement on orthopedic and trauma admissions at kenyatta national teaching and referral hospital kenya a pre post test design |
| topic | health hospitals lesions orthopaedics |
| url | https://hdl.handle.net/10568/175997 |
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