Septic Arthritis: A Need to Strengthen the Referral Chain in a Developing Economy

ABSTRACT Aim: This retrospective analysis documents the features and factors that potentially affect outcomes in septic arthritis in the Cross River Basin area of south-south Nigeria. Patients and Methods: A retrospective analysis of 43 patients who presented with septic arthritis in 45 joints between September 2007 and August 2010. All patients with pain, fever, joint swelling and non-weight bearing/refusal to move the limb and had a joint aspiration productive of a turbid and/or purulent aspirate were included in the analysis. Patients whose joint aspiration produced frank blood or a clear exudate were excluded. Results: There were 24 males and 19 females (M:F = 1.3:1). Forty patients were children while three were adults. Thirty-three patients were urban dwellers, 8 were semi-urban dwellers and 2 were rural dwellers. Twenty-five children were first seen by a Paediatrician. Only 5 patients were first seen by an Orthopaedic surgeon. Definitive treatment was conservative in 28 children and arthrotomy/washout in 12 children and 3 adults. Staphylococcus aureus was the commonest isolated pathogen in both age groups. Conclusion: Injudicious interventions in musculoskeletal conditions consist not only of traditional bone setting and other unorthodox practices, but also sub-optimal orthodox medical practices. Healthcare outcomes in Africa are a function of the skewed distribution of the healthcare workforce and a weak referral chain. The near absence of follow-up culture underscores the need for education on injudicious antibiotic therapy to be directed at patients and physicians. Judicious interventions in musculoskeletal sepsis at first contact and a strengthening of the referral chain are important

An audit of the completion of radiology request forms and the request practice

Objective: To assess the degree of utilization of the radiology request form (RRF), the extent of completion each form, the frequency of filling the fields in all the forms, and its effectiveness as a communication tool between the referring clinicians and radiologists. Materials and Methods: All the RRFs for conventional radiographic examinations were audited over a 3-month period. A database containing all the fields in the form, type of request paper used, and legibility of the physician′s handwriting was created. A few resident radiologists in the plain film reporting unit were recruited to join in collecting the data daily. We used simple statistical methods to analyze the extent of completion of each form, frequency of completion of the fields in all the request forms, frequency of use of the appropriate form, and frequency of legibility of the physician′s handwriting. The results are expressed in percentages. Results: Five hundred eighty (580) requests were analyzed, consisting of 180 for males and 400 for females. The most-completed request form was 86.67% filled, while the least-completed was 26.67%. The most frequently filled field was the requested examination (99.66%). Of the clinicians, 28% did not use the RRF for their referrals, while 7.37% had illegible handwriting. Conclusion: A significant number of the referring clinicians did not make the best use of the radiology department by not using the institution′s approved RRF as an effective means of communication with the radiologists, mainly due to the inadequate completion of the forms