Patterns of referral to Red Cross War Memorial Children's Hospital, Cape Town

Patterns of referral to Red Cross War Memorial Children's Hospital were studied to assess the appropriateness of referrals. From 1 July to 31 December 1987 all 9288 referral letters presented to the hospital were collected and a sample (4662 letters) analysed. It emerged that the patients were similar to those attending the outpatient department without referral, except that relatively fewer referred patients were black. The private sector, i.e. general practitioners, was the largest referral agency, followed by day hospitals. Most patients were referred to the outpatient department without an appointment. Of the specialist clinics, the surgical clinics (i.e. ophthalmology and ear, nose and throat) had the highest number of referrals. The majority of patients (84,9%) were not admitted. Only in 30,3% of referred cases did the hospital make contact with referral agents. Referral rates were highest from the predominantly coloured areas of the Cape Peninsula. The hospital cannot isolate itse" from the community it serves and needs to support and guide referral agents in order to improve the utilisation of the hospital. Training of health professionals in order to increase expertise is a priority. A study of the total patient population would facilitate the understanding of hospital utilisation. Similar studies could be beneficial at other hospitals

Utilisation of outpatient services at Red Cross War Memorial Children's Hospital, Cape Town

The demand for outpatient services continues to grow at Red Cross War Memorial Children's Hospital (RCCH). To determine current utilisation patterns, we conducted a 2-week survey in the outpatient department (OPD). In addition, we reviewed the RCCH Annual Reports for the period 1961 - 1988. Annual outpatient attendances have increased from around 42000 in 1957 to their highest level ever; nearly 350000 in 1988. This steady rise in outpatient attendance was stemmed during the 1970s by the expansion of health services in the greater Cape Town area, in particular the introduction ofday hospitals. In general, blacks are utilising the OPD as a primary community hospital for the treatment of infectious and environmentally induced diseases. In contrast, the white outpatient profile is more characteristic of a tertiary referral centre, with a higher proportion of specialist clinic attendances. The utilisation patterns for coloured children are intermediate. Analysis of the residential address of patients and their presenting diagnoses indicates an urgent demand for primary health care services in the most recently settled and poorest suburbs of Cape Town, many of which are remote from the hospital

The referral letter - a problem of communication

This cross-sectional ,descriptive study assesses the letters sent with referred patients to Red Cross War Memorial Children's Hospital, Cape Town, and makes appropriate recommendations. During the 6-month period 1 July - 31 December 1987, 9 288 letters were photocopied at the admissions offices of the hospital. A sample of the letters collected, systematically stratified to represent the available days during the study, was analysed. Detailed analysis of 1143 (12,3%) letters was undertaken. The private sector, i.e. general practitioners, was the largest referral agency, followed by communitybased day hospitals. The quality of information in referral letters was comparable to that found in other studies. The quality of letters influenced the writing of replies by hospital staff. There is a need to develop ways of improving communication between hospital staff and referral agents