Access to essential surgical care in district hospitals of Sarawak Malaysia: outcomes of an audit and the need for urgent attention.

Abstract

Since access to essential surgical care (ESC) in rural Sarawak, Malaysia, remains subpar, this study aimed to identify pitfalls in its ESC delivery and possible solutions to improve it. This cross-sectional study was undertaken in the Sarawak General Hospital between January 2019 and December 2019. It assessed the caseload of five essential surgical procedures referred from nearby district hospitals. It analysed the number of patients stranded in the accident and emergency department, their waiting time for ward transfer and the duration between admission day and timing of surgery for patients with appendicitis. There were 259 referrals for one of the five essential surgical procedures. The baseline characteristics between the referred and the local cohorts of patients for the designated procedures were comparable in terms of gender (P= 0.486), body mass index (P= 0.598) and ASA score (P= 0.284), with the exceptions being that the referred cohorts were older (43.2 vs. 39.7, P= 0.008) and with different racial composition (p< 0.001). The mean number of patients stranded in emergency department was 34.2± 4.9 per day and the mean bed waiting time was 21.4± 6.3h. For patients who required appendicectomy, 70.8% of patients had surgery performed within 24 h of admission. The delivery of ESC in Sarawak's district hospitals demands urgent attention for improvement. The action framework proposed outlined six priorities: infrastructure development, service delivery, surgical training, finance, information management and governance.