Perceived diagnostic and system-related barriers to timely referral and interfacility transfer of trauma patients in Namibia: a cross-sectional survey

Introduction Patient transfers aim to ensure continuity of care, but referral-transfer pathway processes are often time-consuming and encounter various delays. This study determined healthcare workers’ perceptions of clinical and non-clinical factors contributing to delays in the transfer process of critically injured trauma patients from the Otjozondjupa District Hospitals to the Windhoek Referral Hospitals and explored mitigation strategies. Methods A cross-sectional online survey was conducted in 2023 at three district hospitals, private and parastatal ambulance services in the Otjozondjupa region, Namibia. Healthcare workers employed in Emergency Centres and Prehospital Emergency Care Providers, working in the setting for 6 months or longer, were eligible to participate. We used convenience and snowball sampling. Results Of the 50 respondents, 64.0% (n = 32) worked in Emergency Centres. Thirty-nine (n = 39, 78.0%) perceived referral/transfer delays. Diagnostic imaging and medical procedures were perceived clinical factors contributing to delays. Non-clinical/system-related factors included bed, ambulance, and medical doctor availability, a lack of human resources and management protocols, and limited knowledge of existing policies and procedures. Suggested mitigating strategies centred on targeted training needs, improved resource allocation, and enhanced Information Technology systems. Conclusion Healthcare workers perceived diagnostic processes, stabilisation procedures, and system-related constraints as barriers to timely interfacility transfer of critically injured trauma patients. Improving time to definitive care may benefit critically injured trauma patients while easing pressure on facilities caring for other urgent patients. These findings may inform local reviews of trauma-transfer processes and support future prospective studies that measure actual transfer times and objectively confirmed causes of delay.