50% paediatrics emergency referrals at PGI come from Rajindra Hospital
More than 50 per cent of the emergency referrals at the Advanced Paediatrics Centre in PGIMER come from one hospital—Rajindra Hospital, Patiala. This was revealed after the PGI doctors, who are struggling to find ways to manage the overcrowded emergency, analysed the data of referred cases for three months.
The emergency ward at the paediatrics centre has 22 beds but at a given time, there are 150 children, who are admitted. As a result, three to four children have to share a bed at the paediatrics emergency.
The doctors had started a thesis, six months ago, to search the referral patterns and the effect on the referral practices after instituting an interventional module.
“We checked the total number of referrals in the first three months, and tried to find out which hospital is sending maximum referrals. We had about 1,200 referrals in the paediatrics emergency. Out of these, more than 50 percent of the cases were from Rajindra hospital,” said a doctor.
“We are in the process of developing a module for streamlining referrals. As a part of the study, we have developed a module to train and sensitise the doctors in peripheral hospitals about the need for a good referral, and perils of bad referrals,” said a consultant.
“We are approaching hospitals in adjoining areas telling them not to refer easily manageable cases such as diarrhoea and pneumonia to PGIMER and if at all they are sending, then they should stabilise the patient first and then refer it. If the patient is not stabilised, even PGI won’t do much,” said a senior consultant at PGI.
Doctors have already visited Rajindra hospital. They are planning to cover other hospitals in the Punjab, Haryana and Himachal, and in the final phase they will assess the impact of this practice in the third phase.
BACK REFERRALS, A SOLUTION FOR OVERCROWDING
The Advanced Paediatrics Centre has found a solution to overcrowding—back referrals and coordination with hospitals from where the maximum cases are being referred.
“Back referrals are practice where patients are given initial treatment to stabilise them. Once the patient is stabilised, we then send them to level two nurseries in the periphery,” the consultant said.
Level-two nurseries are called as sick neo-natal care units (SNCUs). The neonatal (1 day to 1 month old) team has made a list of SNCUs in the periphery of Haryana and Punjab. When they find that a neonate is stable and can be shifted, they call the SCNU, which is near to the patient’s home.
“We refer quite often to SNCUs in Panchkula, Ambala, Una, Patiala. Mostly back referrals have been to Haryana, as SNCUs came a little earlier in Haryana than Punjab,” said another doctor from new-born unit. In a week, one or two neonates are referred back from newborn unit. On an average about 3-4 newborns are referred back per day from emergency to SnCU.
For back referrals of children up to 12 years, doctors have networked with selected hospitals. It includes hospitals such as GMCH-32 and GMSH-16; Command hospital, Chandimandir; Rajindra hospital, Patiala; IGMC, Shimla, DMC and CMC in Ludhiana and at times PGIMS in Rohtak.
“The problem comes as patients hesitate. Parents are not willing to take back children or neonates to any other hospital. Even if they go to other hospital, they keep on nagging and the other doctors send them back to PGI. We get re-referrals,” said the consultant.
Earlier PGIMER’s former director Dr YK Chawla had said, “Referring back could be a good suggestion. In fact recently, we have written and spoken to hospitals, at least as far as neonates is concerned. May be if it works out well, we could adopt it to refer back adults also in different specialities. We could try that out.”