After years of complaints about critically ill or injured patients being shunted from one government health facility to another, losing precious time during transfers, the Punjab health department has revised its emergency referral mechanism, making prior coordination between the referring and receiving hospitals mandatory to ensure that the person in need of medical care reaches a facility equipped to provide the required treatment.
Until now, patients could be referred to the nearest higher-level health facility without prior coordination, potentially leading to further referrals if the required specialist or treatment was unavailable.
The department has introduced a standard operating procedure (SOP) for closed-loop referral services across government healthcare facilities, including district hospitals, sub-divisional hospitals, community health centres (CHCs) and government medical colleges.
The new protocol, a copy of which is with HT, aims to prevent unnecessary transfers, ensure timely access to specialised treatment and fix accountability for referrals between facilities. The department has directed designated government healthcare facilities to implement the protocol at the earliest.
The problem is particularly acute in road accident cases in rural areas, where injured people are often rushed to nearby CHCs that lack specialist doctors.
They may then be referred to a civil hospital, and if the required treatment or specialist is unavailable there, they are transferred again to a district hospital or other higher facility.
{{/usCountry}}They may then be referred to a civil hospital, and if the required treatment or specialist is unavailable there, they are transferred again to a district hospital or other higher facility.
{{/usCountry}}Such successive referrals can waste crucial time before medical intervention. The immediate medical intervention after a road accident can improve the chances of survival in case of critically injured people.
According to the communication, the referrals will be classified into three categories: red, yellow and green. Red-category cases include conditions such as polytrauma, head injuries accompanied by loss of consciousness, ST-elevation myocardial infarction (STEMI), stroke, postpartum haemorrhage, eclampsia and respiratory failure.
Yellow- and green-category referrals will be classified according to the severity of the injury and patient’s condition.
The new SOP explicitly provides for bypassing an intermediate facility when it lacks the required treatment services.
“The patient will be referred to a facility where the required linkage and clinical capabilities are available. Patients should not be unnecessarily transferred from one facility to another as per the prescribed referral hierarchy. If an intermediate facility does not have the required definitive treatment services, it may be bypassed as per the referral mapping,” says the SOP.
The protocol adds that the emergency medical officers will be required to assess and stabilise patients before referral. “In critical cases, ambulance services must be activated, while the receiving hospital must be informed about the patient’s clinical condition and expected arrival time. The receiving facility will have to acknowledge the referral and communicate whether it can provide the required treatment,” it adds.
If the receiving facility refuses a referral, the reasons must be recorded, and an alternative destination should be identified in coordination with the referring hospital. The protocol also provides for the transfer of relevant clinical information and a formal handover to the receiving medical team.
Dr Akhil Sarin, state president of the Punjab Civil Medical Services Association, said the SOP was much needed as it would plug gaps in referral linkages.
“This is the need of the hour. It will make the referral system more robust and accountable by plugging gaps in referral linkages and preventing avoidable delays, thereby ensuring the seamless transfer of patients to appropriate healthcare facilities,” he said.
GFX
Monitoring & accountability
Designated referral nodal officers with official mobile phones to strengthen coordination between healthcare facilities
Govt med colleges will set up referral coordination mechanisms
WhatsApp groups to serve as an interim arrangement before rollout of integrated state digital referral platform
Referral directory to list available specialities, clinical capabilities, contact persons and key contacts
District referral nodal officers to monitor compliance, with civil surgeons and medical superintendents reviewing referral data
Framework to track referral numbers, acceptance and refusal rates, reasons for refusal, response times, feedback and deaths