Referral protocols for patient safety thrown to winds

Mocking at the Government’s claims of streamlining referrals especially for expecting mothers, patients are being sent to LalDed Hospital with notes scribbled by doctors on paper scraps, skipping documentation recently mandated to ensure patient safety at both referee and referred institutions.

A source at Kashmir’s tertiary care maternity hospital LalDed said that documents of patients referred to the hospital from peripheral institutions reveal the “callousness” of doctors while sending patients.

Most referral papers of patients received at LalDed Hospital in April, the source said, were a proof of how healthcare was deteriorating with unnecessary referrals. “Some referrals have been scribbled on the notebook pages, some on the plain paper while others, if made on hospital cards, bear no information on who referred the patient and why,” the source said.

In February this year, health and medical education department had formulated standard operating procedure for ensuring accountability and safety of patients.

Directions had been passed to all healthcare institutions that whenever a patient was referred, the referral must bear the name, signature, seal, designation and registration number of the doctor making the referral.

Government had also mandated that a patient being referred in an ambulance be accompanied by a medical attendant or ASHA worker “well-versed” with resuscitation drill. The patient upon reaching the tertiary-care hospital must be “handed-over” to the doctor on duty “under proper receipt indicating date and time of handing over the patient”.

After being received by doctor-on-duty, the Registrar on duty would need to be informed about the patient, the latter taking on the management of the patient from thereon “within shortest period of time”

A senior doctor at LalDed Hospital alleged that no arrangements had been put in place in peripheral hospitals to reduce the unnecessary referrals to LalDed Hospital.

“LD is a tertiary care hospital where the focus should have been on high risk cases rather than providing services that can very well be made available in a primary health center as well,” she said.

The doctors said that north Kashmir continued to have the maternity services hinged on referring patients. “After 4 pm, most of the hospitals in the northern districts have only one doctor in the hospital whose job is scribble note to refer patient,” she said.

Another doctor at LD Hospitals said that the directorate had failed to create functional 24×7 maternity centers which was the basic cause of unnecessary referrals. “They have their staff scattered at places where there is no role for them,” the doctor said urging the Government to focus on creating secondary level referral centers at the upcoming Government Medical Colleges Anantnag and Baramulla. “Women in Kashmir will only then have some decent maternity services here,” she said.

Director Health Services Kashmir, DrKunzes Dolma when asked about the laxity in patient referrals to LalDed Hospital said that her department was “sensitizing doctors” about the referral procedure.

“The attitude of healthcare workers in Kashmir needs to be changed and we are working towards it,” she said adding that “it was bound to take time”.

“Things cannot change overnight,” she said while referring to SOPs.