BACKGROUND Timely access to emergency obstetric care is crucial in preventing mortalities associated with pregnancy and childbirth. The referral of patients from lower levels of care to higher levels has been identified as an integral component of the health care delivery system in Ghana. To this effect, in 2012, the National Referral Policy and Guidelines was developed by the Ministry of Health (MOH) to help improve standard procedures and reduce delays which affect access to emergency care. Nonetheless, ensuring timely access to care during referral of obstetric emergencies has been problematic. The study aimed to identify barriers associated with the referral of emergency obstetric cases to the leading national referral centre. It specifically examines the lived experiences of patients, healthcare providers and relatives of patients on the referral system. METHODS Korle Bu Teaching Hospital, Accra was used as a case study in 2016.The qualitative method was used and in-depth interviews were conducted with 89 respondents: healthcare providers [n = 34];patients [n = 31] and relatives of patients [n = 24] using semi-structured interview guides. Purposive sampling techniques were used in selecting healthcare providers and patients and convenience sampling techniques were used in selecting relatives of patients. RESULTS The study identified a range of barriers encountered in the referral process and broadly fall under the major themes: referral transportation system, referrer-receiver communication barriers, inadequate infrastructure and supplies and insufficient health personnel. Some highlights of the problem included inadequate use of ambulance services, poor management of patients during transit, lack of professional escort, unannounced emergency referrals, lack of adequate information and feedback and limited supply of beds, drugs and blood. These findings have implications on type II and III of the three delays model. CONCLUSIONS Initiatives to improve the transportation system for the referral of obstetric emergencies are vital in ensuring patients' safety during transfer. Communication between referring and receiving facilities should be enhanced. A strong collaboration is needed between teaching hospitals and other stakeholders in the referral chain to foster good referral practices and healthcare delivery. Concurrently, supply side barriers at referred facilities including ensuring sufficient provision for bed, blood, drugs, and personnel must be addressed.

中文翻译：

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改善中低收入国家的紧急产科转诊系统：对加纳第三级医疗机构的定性研究。

背景技术及时获得紧急产科护理对于预防与妊娠和分娩有关的死亡率至关重要。在加纳，已经确定将患者从较低的护理水平转到较高的护理水平是医疗服务体系不可或缺的组成部分。为此，卫生部（MOH）在2012年制定了《国家推荐政策和指南》，以帮助改善标准程序并减少影响获得急诊服务的延误。但是，确保在转诊产科急诊期间及时获得护理仍然存在问题。该研究旨在确定与紧急产科病例转诊至领先的国家转诊中心相关的障碍。它专门检查患者的生活经历，医疗保健提供者和患者亲属的转诊系统。方法采用阿克拉Korle Bu教学医院为例，于2016年进行了定性研究，对89位受访者进行了深度访谈：医疗服务提供者[n = 34];患者[n = 31]和患者的亲属[n = 24]使用半结构化面试指南。目的抽样技术用于选择医疗保健提供者和患者，便利抽样技术用于选择患者的亲属。结果该研究确定了转诊过程中遇到的一系列障碍，并大致归入以下主要主题：转诊运输系统，推荐人与接收者的沟通障碍，基础设施和供应不足以及卫生人员不足。问题的一些突出之处包括没有充分使用救护车服务，过境期间对患者的管理不善，缺乏专业陪同，没有事先宣布的紧急转诊，缺乏足够的信息和反馈以及床，药品和血液的供应有限。这些发现对三种延迟模型的II型和III型有影响。结论改善产科急诊转诊运输系统的举措对于确保患者在转移期间的安全至关重要。转诊和接收设施之间的通信应加强。在教学医院和转诊链中的其他利益相关方之间需要强有力的合作，以促进良好的转诊实践和医疗保健提供。同时，