PGIMER study reveals sources of referrals, overcrowding at hospital

Chandigarh: The PGIMER in a recent drive to check its overcrowded Advanced Pediatrics Center's emergency referrals, discovered 50% of the rush came from Rajindra Hospital, Patiala alone. This discovery was an outcome of toiling PGIMER doctors, trying to find ways to manage an overflowing emergency. On studying the statistics of referral cases, they discovered the source of the rush, as well as the reasons for it. A solution for overcrowding in the form of back referrals and coordination with hospitals, from where the maximum cases came was reached. An in depth study initiated by the hospitals six months ago led to this conclusion.

The thesis initiated six months ago, after instituting an intervention mode, also studied referral patterns and the effect they had on referral practices.With a 22 patient bed strength, the PGIMER Advanced Pediatrics Center is usually flooded with a 150 children at a given time; resulting in three or four children on a bed at one time at the pediatric emergency .

“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 pediatrics emergency. Out of these, more than 50 percent of the cases were from Rajindra hospital,” said a doctor.

The hospital having alerted itself to the source and reason for referral rush, has now started working on ways and means, to streamline- referrals.

As part of their study, the PGIMER has taken on the herculean task of sensitizing doctors of peripheral hospitals, about the need of a good referral and the dangers of a bad one.

“We are approaching hospitals in adjoining areas telling them not to refer easily manageable cases such as diarrhea and pneumonia to PGIMER and if at all they are sending, then they should stabilize the patient first and then refer it. If the patient is not stabilized, even PGI won’t do much,” said a senior consultant at PGI.

Besides visiting the Rajindra Hospital, the PGIMER team also plans to cover peripheral hospitals of Punjab, Haryana and Himachal. The final phase of the study would assess the impact of the exercise undertaken.

Talking about back referrals, the solution found for overcrowding, a consultant of the hospital said “Back referrals are practice where patients are given initial treatment to stabilize them. Once the patient is stabilized, we then send them to level two nurseries in the periphery.”

The doctors of PGIMER have also made a list of the level two nurseries called sick neo-natal care units (SNCUs), in the periphery of Haryana and Punjab, where children in stable condition can be transferred to decrease overcrowding. The SCNU has to be one close 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 from the PGIMER are referred back from newborn unit; on an average about 3-4 newborns are referred back per day from emergency to SNCUs.

The PGIMER has selected a few hospitals like the GMCH-32 and GMSH-16; Command hospital, Chandimandir; Rajindra hospital, Patiala; IGMC, Shimla, DMC and CMC in Ludhiana and PGIMS, Rohtak, for back referrals of children up to 12 years of age.

“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 hospitals, 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 specialties. We could try that out.”