Pre-referral stabilization and timeliness as predictors of adverse events among adult medical patients referred to a tertiary hospital

Background: In Tanzania, despite of great efforts in improving hospital infrastructures to enhance pre referral communication between referring hospital and receiving hospital and hasten patient transfer still we have gaps in knowing the time interval from decision of referring patient to time the patient arrives at the receiving hospital. Furthermore, the status of appropriateness of pre referral stabilization and its relation to occurrence of adverse events is still unknown.
Objective: To evaluate pre referral stabilization appropriateness and timeliness as adverse events predictors among medical adult patients referred to Muhimbili National Hospital
Methodology: Prospective study conducted among critically ill non traumatic adult patient referred to Muhimbili National Hospital in 3 months period. Participants with NEWS2 Score 5 or more were enrolled using consecutive sampling technique. Validated structured questionnaire was used to assess the level of stabilization done on compromised Airway, breathing, Circulation, Disability of the patient on arrival. Information on demographics, and timeliness were recorded. Predictors of adverse outcome were evaluated using multivariate logistic regression analysis. 
Results: Enrolled 351 patients. Primary survey included compromised airway 62(17.7%), breathing 153(43.6%), circulation 164(45.8%), and hypoglycaemia 6(3.9%). Interventions done were 3(13.5%) suctioning among with secretions, airway adjuvant placement 3(6.9%) among with inability to protect airway. Oxygen therapy was given in 71(46.4%) among 153 with hypoxia. Among hypotensive patients, intravenous fluid was given 27(38.6%) and hypoglycaemia correction in 1(16.7%). Time from referral decision to arrival, pre-referral stabilization in breathing and circulation were shown to predict adverse events.
Conclusion: Time from decision to refer patient to time of patient arrival at tertiary hospital, and appropriateness of pre referral stabilization of breathing and circulation were independent predictor of adverse events.