Health system: limited responsiveness detected in references for surgical care, Hospital Escuela Universitario, Tegucigalpa

Abstract

Background: Hospital Escuela Universitario (HEU) provides 24/7 healthcare and receives patients referred nationwide. Objective: To identify the characteristics of health units and patients referred to General Surgery Emergency Room, HEU, May- July 2013. Methodology: Cross-sectional study on patients referred for surgical care to General Surgery Emergency Room. Prior verbal informed consent, data were collected through interviews to patients and companions, review of reference form and medical chart. We recorded demographic and clinical information and transfer conditions. Characteristics of health units were also evaluated. Results: There were 844 referred patients, 20.5% of the 4,114 patients evaluated in the period. The 66.1% (558) was referred from Francisco Morazán health centers; the rest, came from El Paraíso 10.2% (86), Comayagua 6.8% (57) and Olancho 3.8% (32).From regional hospitals references (103), 20% (48) came from Hospital Santa Teresa, Comayagua, and 18.0% (43) from Hospital Gabriela Alvarado, El Paraíso. The reasons for referral included lack of specialized physicians and supplies together (62.9%), lack of specialized physicians only (27.4%) and supplies only (4.6%), and patient´s lack of financial resources (3.1%). Among the clinical conditions, 26.7% (225) were referred for abdominal pain. The 4.0% (31) was received in unstable conditions and 5.2% (44) with impaired consciousness. Discussion: The Honduras Sanitary System shows lack of qualified personnel and supplies for surgical care. The reference for unjustified reasons brings negative impact to the patient, the family and the recipient centre. A successful system requires organization, integration and interrelation between the different levels of care.