Night rounds in DHs, SDHs mandatory to curb tertiary care hospital referrals

Srinagar, Nov 15: Amid the reports of unnecessary referrals, the Directorate of Health Service Kashmir (DHSK) has made it mandatory for Medical Superintendents of District hospitals and Sub-District Hospitals to conduct night rounds.

The directive, issued by the DHSK on the explicit instructions of the Chief Secretary of Jammu and Kashmir, aims to alleviate the burgeoning crisis of unnecessary referrals to tertiary care hospitals.

As per the fresh instructions, the Chief Medical Officers (CMOs) and Medical Superintendents of district hospitals in the Kashmir division have been directed to personally oversee night rounds in hospitals under their jurisdiction.

"The primary objective is to ensure that unwarranted referrals are curtailed, thereby preventing an overwhelming influx of patients into tertiary care hospitals," an official said.

The officials have been directed to submit a comprehensive list of referred patients to tertiary care hospitals on a fortnightly basis.

"This list must include complete patient details and reasons justifying the referrals," the order reads.

The stringent measure has been taken to enhance accountability and transparency in working of district and sub-district hospitals and put a check on the referral process.

"The move will also streamline the functioning of the rural health care centres as well," an official said.

The backdrop to this directive is the ongoing referral chaos plaguing tertiary care hospitals in Srinagar.

This newspaper earlier reported about the crisis because of the patients being referred from district hospitals to city hospitals. The consequences of this referral chaos are dire, with critical "golden hours" lost for patients experiencing medical emergencies.

As per the figures, Sher-e-Kashmir Institute of Medical Sciences (SKIMS) alone received over 18,000 referral cases annually. Lal Ded Maternity Hospital handles more than 10,000 referrals annually, while SMHS Hospital receives around 3,500 such cases.

The Bone and Joint Hospital reports that 18 percent of its patients are referrals, and a staggering 70 percent of the 850 to 900 cases in the Out Patient Department (OPD) at CD Hospital come from different districts.

SKIMS data further highlights the extent of the problem. In addition to direct referrals, approximately 600 emergency cases and 3,000 OPD cases each month come from different districts in Kashmir.

An official said the purpose of making night rounds mandatory in hospitals was to address the escalating crisis, placing emphasis on a proactive approach at the district and sub-district levels.

"The hope is that by implementing night rounds and scrutinizing referrals, the burden on tertiary care hospitals can be alleviated. Ultimately it will improve the efficiency and effectiveness of the healthcare system in the region," the official said.

He said the move will ensure coordination between the referring hospital and the accepting hospitals, in case genuine cases are referred to city hospitals.

"We don't say that referrals are always unjustified but in case a patient is referred to a tertiary care hospital, prior information is given to the accepting hospitals about the patient so that they remain aware about the referral case and be ready with necessary arrangements," the official said.