District Hospital Trauma Mental Health Screening Night-Shift Staffing Ratios and Post-Traumatic Stress Disorder Referral Completion in Ugandan Clinics: A Multilevel Analysis of After-Hours Detection Capacity

Night-shift staffing ratios in district hospital trauma units determine whether post-traumatic stress disorder (PTSD) screening can be completed and whether survivors are referred onward, yet the relationship between after-hours detection capacity and referral completion remains poorly quantified in low-resource settings. The model specifies three nested levels: the patient encounter, the night-shift staffing configuration, and the district referral system. It proposes that staffing ratios operate on referral completion through two mediating mechanisms, screening completion and documentation quality, and that these mechanisms are moderated by trauma caseload volatility and by the availability of same-night supervisory review. The analysis is conceptual and methodological rather than empirical: no primary data were collected. The paper derives testable propositions, specifies the multilevel estimator that would identify the proposed pathways, and identifies the boundary conditions under which staffing-ratio effects on referral completion should be expected to attenuate. The contribution is a formalisation of after-hours detection capacity as a measurable organisational construct and a design for the multilevel study that would estimate its effect on PTSD referral completion in Ugandan district hospitals.