The transfer process of patients with obstetric emergencies arriving by ambulance to Kawempe National Referral Hospital

Abstract

Introduction: In Uganda 2% of women die from maternal causes with the current mortality ratio of 375 maternal deaths per 100,000 live births. Uganda lacks a functional ambulance system and transfers are categorized by government and non-government owned ambulances that transport obstetric emergencies to higher level facilities. This system lacks standards and inter-facility transfer protocols. There are limited studies which asses the state of Emergency Care Services in Uganda but none has been done to assess the transfer of patients with obstetric emergencies. Objective: To describe the transfer process of patients with obstetric emergencies arriving by ambulance to Kawempe National Referral Hospital (KNRH). Methods: The study recruited 215 participants in a descriptive cross-sectional study at KNRH in Kampala, Uganda. Trained research assistants enrolled participants that met the inclusion criteria consecutively on arrival by ambulance at the hospital. Using a questionnaire, quantitative data was collected from the ambulance driver, referral form and ambulance log book. The sample size was 215. Results: The median age was 27 years and the majority of patients were referred because of hypertensive disorders (34.9%), obstructed labour (26.5%) and haemorrhage (20.9%). The median total response time taken for transfer of patients with obstetric emergencies was 50 minutes. About 63.3% patients with obstetric emergencies transported by government owned ambulances did not have medical escort. Nearly 92.3% of the patients escorted by Emergency Medical Technicians (EMTs) had three different types of vital signs recorded. Conclusions: The transfer process of patients with obstetric emergencies does not have standards and lacks protocols. This study offers insights into the process of ambulance transfers which is a critical component of EMS systems in Uganda. This study creates an opportunity to benchmark on developing systems that will improve ambulance services for all emergencies.