KNH big headache as accident patients refer themselves for admission

Victims of accidents around Nairobi are still referring themselves to Kenyatta National Hospital, further straining its facilities.

Nearly half of the patients referred themselves and most said they believed there were no medics to treat them in the level 4 and 5 facilities around them.

This is according to a report by researchers from the department of orthopaedics, University of Nairobi and KNH, after reviewing 905 patient admission charts for 2021.

KNH is a level 6 facility whose admissions should ideally be referrals. However, the vast majority of patients go there before seeking help from lower level hospitals.

“As a result, the tertiary facility effectively functions as a primary healthcare facility,” the researchers said.

A poor referral management not only results in lost revenue but clogs higher level facilities leading to poor services.

The researchers said about 50 per cent of orthopaedic and trauma patients at KNH were facility referrals, while 49.9 per cent were walk-ins.

At least, 48.7 per cent of all were victims of road traffic crashes, 21 per cent were due to falls and non-trauma-related conditions at 17.2 cent.

The vast majority of self-referred patients came from within the Nairobi Metropolitan area consisting of Nairobi, Kajiado, Machakos and Kiambu counties.

The authors have advised these county governments to improve their facilities to help decongest KNH.

Some health facilities with orthopaedic surgeons still refer multiple fracture and trauma patients to KNH due to lack of other specialist personnel like neurosurgeons, Intensive Care Units or High Dependency Units care.

“There is need to educate the general public on the role of KNH as a referral health facility and patients encouraged to visit lower-tier health facilities for essential orthopaedic and trauma care,” the authors said in their analysis, which has been published in the Plos Public Health journal.

It is titled: “Patterns of facility and patient related factors to the orthopedic and trauma admissions at the Kenyatta National Hospital”.

The authors are Maxwell Omondi, Joseph Mwangi, Fred Sitati and Herbert Onga’ngo.

In total, human resource capacity and availability were the most frequently cited reasons for bypassing the nearby health facilities at 42 per cent.

Patients’ preference was the second most frequently cited reason for bypassing the nearby health facilities at 23.4 per cent.

“Patient prefers KNH since family members have been treated there and fully recovered,” said one patient quoted by the authors.

Financial constraints were the third most frequently cited reason for bypassing the nearby health facilities at 23.3 per cent.

Patients also said private hospitals near them were not accredited by the NHIF.

Other reasons given included the availability of equipment at KNH.

The patients consider KNH to have superior and capacious infrastructure to handle complex orthopaedic complications.

“I opted for KNH after getting advice from several people who had attended Mama Lucy Hospital,” said one walk-in from Mathare North.

A 2019 report by the National Assembly’s Health Committee revealed that the poor referral system has caused acute understaffing and perennial underfunding, among other problems in the top hospitals.

The report focused on national government-managed referral hospitals such as KNH, Moi Teaching and Referral Hospital (MTRH), the National Spinal Injury Hospital (NSIH) and Mathari National Teaching and Referral Hospital (MNTRH).

“The nursing cadre was the most understaffed with an average nurse to patient ration being 1:20. In certain wards, this could go as high as 1:50,” the report read.

KNH treats an average of 2,093 inpatients and 2,500 outpatients daily.

The hospital has a bed capacity of 1,800.

“The hospital is overcrowded due to broken referral systems. The hospital also closed its outpatient clinic that had been previously used to decongest the main hospital,” the committee reported.

It was chaired by former Muranga’ Woman Representative Sabina Chege.

The report says the nursing cadre is the worst hit. At times one nurse is forced to take care of as many as 50 patients.

“The nursing cadre was the most understaffed with an average nurse to patient ration being 1:20. In certain wards, this could go as high as 1:50,” read the report.