Kashmir’s Healthcare Dilemma | SOPs, directives struggle to stop tertiary hospitals’ referral tide

Srinagar, Oct 8: Despite Standard Operating Procedures (SOPs) and resolute directives aimed at curbing the tide of unnecessary patient referrals to tertiary care hospitals, the healthcare system in Kashmir remains ensnared in a web of burdens.

As the tertiary care hospitals in Srinagar strive to provide quality healthcare to residents, the relentless surge of referrals from the district and peripheral healthcare centres casts a daunting shadow over its efforts.

As per the rough estimates of the health department, over 40,000 patients are referred from district hospitals and rural healthcare institutions to tertiary care hospitals in Srinagar, creating an additional burden on these healthcare facilities.

The majority of referral cases are managed at Sher-e-Kashmir Institute of Medical Sciences (SKIMS), followed by Shri Maharaja Hari Singh (SMHS) Hospital, Lal Ded Hospital, and the Chest Diseases Hospital.

Doctors working in these tertiary care hospitals have voiced concerns about the overburdening effect of unnecessary referrals from sub-district and district hospitals.

One senior doctor at SMHS Hospital recounted a specific occurrence in which a district hospital, facing a shortage of cardiologists due to vacation leaves, directed a heart attack patient to a tertiary care hospital.

“Surprisingly, instead of limiting the referral to the critical case, all three heart patients admitted at the district hospital during that period were transferred to Srinagar,” he said.

A doctor at SKIMS said, “Every day, we receive numerous patients who could be efficiently handled at sub-district and district hospitals, yet they continue to be directed to our facility.”

The doctor emphasised that although there were variations in the available amenities between district and tertiary care hospitals, roughly 30 percent of patients are subjected to needless referrals and could instead receive suitable treatment at lower-level medical facilities.

Despite multiple circulars issued by the government to address the issue of unnecessary referrals, the situation on the ground remains largely unchanged.

The doctors believe that although the government has improved the infrastructure of peripheral hospitals, further enhancements are necessary to eliminate excuses for unwarranted referrals.

The Health and Medical Education (H&ME) Department last year announced plans to audit all referrals from district-level hospitals to tertiary care hospitals to optimise healthcare resources and patient services across the system.

“The Principal Secretary to Government, H&ME, has taken strong note of the referrals of patients from district health institutions to tertiary care institutions,” reads the order issued by the government in 2022.

It emphasised the need to curb unnecessary referrals, as they result in a significant burden on tertiary care institutions and the underutilisation of district-level manpower and facilities.

Directorate of Health Services Kashmir (DHSK) spokesman, Dr Mir Mushtaq acknowledged the improvement in facilities at district and peripheral hospitals.

“While referrals can’t be entirely stopped, they are now closely vetted by teams of doctors. Additionally, with the augmentation of facilities in district hospitals and rural healthcare institutions, it is expected that referral cases will decrease, ultimately benefiting the patients,” he said.

A senior official of the Health Department said, “The primary reason behind these referrals is the absence of certain specialists and facilities in rural areas, which are challenging to establish and sustain. The department is currently in the process of establishing CT scan services at the district level and MRI services at all new Government Medical Colleges (GMCs), with reports being transmitted through teleradiology. This initiative aims to alleviate the burden on tertiary care hospitals.”