BENEFITS TO A REGIONAL NEUROSURGICAL UNIT FOLLOWING THE INTRODUCTION OF A DECENTRALIZED IMAGING FACILITY

Objective. To determine whether the establishment of a peripheral comp uted tomography (CT) facility has an influence on the central referral neurosurgical unit, and particularly whether unnecessary referrals ar e avoided. Design. The outpatient records of all patients referred fro m Umtata General Hospital (UGH) to the neurosurgical unit at Wentworth Hospital, Durban, were retrospectively analysed over a 4-year period - 2 years before and 2 after the introduction of CT facilities at UGH. Setting. Wentworth Hospital, Durban, which houses the sole neurosurgi cal referral centre for the region. Patients. Eight hundred and forty patients were referred to the neurosurgical unit from UGH during the 4 -year study period - July 1990 to June 1994. Main outcome measures. 1. The number of referrals to the neurosurgical unit before and after in troduction of peripheral CT facilities at UGH. 2. The admission rate o f the above referrals during the same periods, indicating appropriate referrals. Results. 1. There were 536 patients referred from UGH to th e neurosurgical unit over a 2-year period before the introduction of p eripheral CT facilities, and 304 patients during the subsequent a-year period after introduction of CT facilities at UGH. This represented a 43.3% decrease in patient referrals during a period in which referral s from all other areas increased by 2.6%. 2. The admission rate of pat ients (indicating appropriate referrals) being referred from UGH incre ased from 46.3% before CT facilities to 79.9% after the introduction o f peripheral CT facilities. The admission rate of patients from other areas, excluding UGH, during the same periods, decreased from 50.3% to 46.4%. Conclusion. This audit reveals that following the introduction of CT facilities at UGH, the number of referrals to Wentworth Hospita l's neurosurgical unit decreased by almost half (43.3%). Furthermore, the patients referred after introduction of the peripheral CT facility were more likely to be appropriate referrals (79.9%) than before (46. 4%). Therefore, the provision of CT facilities at peripheral hospitals may effectively serve to exclude those patients who would otherwise b e referred unnecessarily, and enable earlier referral of those patient s who require urgent care at a tertiary neurosurgical unit.