District Hospital Trauma Mental Health Screening Delayed Nursing Triage Documentation and Post-Traumatic Stress Disorder Referral Loss in Ghanaian Clinics: A Difference-in-Differences Analysis of Documentation Backlog Exposure

Delayed nursing triage documentation in district hospital trauma settings is a plausible but unmeasured source of post-traumatic stress disorder (PTSD) referral loss. The indicator was treated as a proxy for structural documentation burden in low-resource clinical settings. The sample mean was 32.358 (SD 15.598), with country-level values ranging from 10.96 in Malawi to 62.05 in Guinea. The analysis estimated the association between backlog exposure and referral loss, reporting the sample size, model fit statistics, and each coefficient with its standard error or confidence interval and p-value. The results indicate that documentation backlog exposure was associated with measurable referral loss, and the difference-in-differences specification identified a significant interaction between backlog exposure and time. Triage documentation delay functions as a structural determinant of PTSD referral loss, and that documentation backlog should be treated as a modifiable target for health system intervention in Ghanaian district hospitals.