Evaluation of the pattern of referrals to a Paediatric Emergency Unit in relation to the outcome of care in Benin City

Background: The referral system is a process where a patient is moved from one level of care to a higher or better level of care for appropriate treatment. Healthcare workers usually initiate referrals, which should be accompanied by a referral letter. Objective: To evaluate the pattern and content of referral notes received in a children’s emergency unit at a tertiary facility in Benin City. Methods: Over six months, a cross-sectional study reviewing all referral notes accompanying children to the Paediatric Emergency Unit of the University of Benin Teaching Hospital, Nigeria was done. Results: Two hundred and six of 300 children (68.7%) had formal written referral letters, while 94 (31.3%) had verbal referrals. Eighty-nine per cent were initiated by healthcare personnel, while clients were initiated in 33 (11.0%) of cases. Doctors made referrals in 238 (79.3%) cases, while 26 (8.7%) referrals were made by nurses. Doctors (182; 76.5%) were more likely to write referrals compared to nurses (9; 31.0%) (χ2 = 32.3, p<0.001). Referrals from medical doctors had significantly better content, including complaints, examination findings, diagnosis investigations, treatment and reason for referral, hospital, name and qualification of doctor (p <0.05). Referral type, source and referring personnel did not significantly affect the mortality of the children (p = 0.24, 0.70, 0.41 respectively). Conclusion: Referrals were more frequently documented and the contents were more comprehensive when written by doctors.