Time to regional surgical care in rural South Africa.

Background: District hospitals in South Africa have limited surgical capacity and regional hospitals treat most essential surgical conditions. This study aimed to describe the pathway and time to regional hospital surgical care for persons with general surgery conditions (PSC) in South Africa.

Methods: This was a retrospective audit of all persons referred on the Vula Mobile App to the general surgery service at Worcester Regional Hospital (WRH) from 1 January 2019 to 31 December 2019. Outcomes were time to care and the proportion lost to follow-up. Reasons for the proportion lost to follow-up were not reported.

Results: There were 617 index PSC referrals to WRH from 23 health facilities. Of these, 472 (76.5%) were referred from district hospitals and 88 (14.3%) from health clinics. Overall, 171 (27.7%) PSC referrals were handled via online-consultation only, 249 (40.4%) were referred to the WRH outpatient clinic, and 197 (31.9%) for inpatient admission. 133 (53.4%) outpatient referrals were lost to follow-up. One hundred and seventy-nine (29.0%) PSC had an operation at WRH. The median number of days from referral to operation was 28 days (IQR:10-86) for those evaluated in the outpatient clinic and 10 days (IQR: 1-125) for those directly admitted as inpatients.

Conclusion: Most surgical referrals to this South African regional hospital came from district hospitals and were for outpatient conditions. The use of telemedicine allowed triage of one quarter of referrals without the need for face-to-face consultation. Median time to operation was less than a month for outpatients; however, there was a high loss to follow-up. Further studies are needed to understand why many PSC did not access outpatient care.