A descriptive evaluation of referral patterns and patient flow from Primary Health Facilities to the Emergency Department Hospital Sungai Buloh.
The Medical journal of Malaysia · 2026-01-01 · Observational study
Abstract
INTRODUCTION: Referrals from Primary Health Facilities (PHF) to hospitals occur due to clinical needs for speciality care in managing the presenting illness, social factors such as poor compliance or lack of family support, and are requested by patients. The journey for any patients transferred from PHF to hospitals has three major components, which are (a) the PHF intervention and activation of ambulances; (b) the Prehospital Care Services (EMS) deployment, care of the patient and transportation to the hospital; and (c) the process of review or admission at the destination hospital. We detail the journey, processing time, and outcomes of patients referred from PHFs via EMS to a tertiary referral hospital in Selangor, Malaysia. MATERIALS AND METHODS: This is a retrospective study analysing data from 980 referred patients from PHFs transported by Klang Valley Ambulance Service (KVAS) to Hospital Sungai Buloh between 1st January 2023 and 30th June 2023. Data collected includes PHF classification, KVAS activation details, patient demographics, Emergency Department length of stay (EDLOS), and the patient's outcome in the ED. Patient's outcome in ED is categorised as (a) admitted; (b) discharged; or (c) discharged against medical advice (DAMA). RESULTS: Out of the 980 referred patients, 83.3% were triaged as Priority 1 by PHFs. The majority were males (56.8%), with a mean age of 28 years. The median waiting time for ambulance arrival was 54-58 minutes. The percentage of referred patients who were admitted to the ward was 65.8%. The median EDLOS was 540 minutes (9 hours), with discharged patients having a shorter median EDLOS of 321 minutes (approximately 5 hours). The median total patient waiting time from PHF to final disposition was 605 minutes (10 hours) for admitted patients and 382 minutes (6 hours) for discharged patients. CONCLUSION: A significant proportion of referred patients experienced prolonged EDLOS, whereas only 22.4% of referred patients were discharged within eight hours. Average EDLOS of 12 hours suggests the need for a "Fast- Track Referral System" to improve efficiency and reduce unnecessary gatekeeping processes.