In view of the complaints of unnecessary referrals from peripheries to tertiary care hospitals, State government today issued the standard operating procedure (SOP) for referrals and ordered strict implementation of the same with immediate effect.
Health and medical education (H&ME) department issued an order (HD/Plan/17/2019) titled SOP for patient referral addressed to principals of government medical colleges of Jammu and Srinagar, director health services Jammu and Kashmir and director Indian System of Medicine (ISM). The order, flagged as “most urgent” has directed that SOPs formulated for referral of patient(s) from one level of health institution to another be implemented strictly. “Any violation in implementation of SOP shall be viewed seriously and disciplinary action, as per the rules, shall be initiated against the defaulters,” the order warns.
The five-page SOP appended to the order has nominated five nodal officers at various levels of healthcare institutions in addition to detailing out the modalities of referrals. The nodal officers are mandated to “ensure implementation of SOPs”.
An official in H&ME department said that Government has enjoined upon the health institutions to create Whatsapp groups to streamline process of referrals. Whatsapp, Government has said, will help in sending immediate information regarding the patient being referred at the destination institution. “On receiving a Whatsapp message regarding patient referral from the referring ‘on-duty’ doctor, nodal officers have been directed to make “necessary arrangements immediately”.
Commissioner Secretary H&ME, Atal Dulloo, said that various steps were being taken to reduce referrals and create better facilities in peripheral areas. “Accountability is one of the arrangements that is imperative and SOP will ensure that,” he said.
Government has mandated that a patient being referred in an ambulance is accompanied by a medical attendant or ASHA worker “well-versed” with resuscitation drill. The patient, upon reaching the tertiary-care hospital, will 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 will need to be informed about the patient, the latter taking on the management of the patient from there-on “within shortest period of time”.
In order to create accountability regarding treatment of referred patients, the order has obligated that the patient can be discharged from tertiary-care hospital “only by or with approval of the on-duty registrar or consultant”.
At the tertiary care level, as well as at peripheral level, log-books regarding details of referred patients and reasons for referral will be maintained, the SOP states.
Government has ordered a monthly audit of all referral cases at all levels of healthcare system in the State. Report of these audits, the order says, will be submitted to the administrative department of the Government.
In GMCs and their associated hospitals, deputy medical superintendents of the hospitals have been designated as nodal officers, in directorates of health services deputy director schemes have been designated as nodal officers, in district hospitals medical superintendents of the hospital will be nodal officers, while at sub-district hospitals and community health centres, senior-most gynaecologist will be the nodal officer.