After years of complaints about critically ill or injured patients being shunted from one government health facility to another, losing precious time during transfers, the Punjab health department has revised its emergency referral mechanism, making prior coordination between the referring and receiving hospitals mandatory to ensure that the person in need of medical care reaches a facility equipped to provide the required treatment.
Until now, patients could be referred to the nearest higher-level health facility without prior coordination, potentially leading to further referrals if the required specialist or treatment was unavailable. The new protocol, a copy of which is with HT, aims to prevent unnecessary transfers, ensure timely access to specialised treatment and fix accountability for referrals between facilities. The department has directed designated government healthcare facilities to implement the protocol at the earliest. The problem is particularly acute in road accident cases in rural areas, where injured people are often rushed to nearby CHCs that lack specialist doctors. They may then be referred to a civil hospital, and if the required treatment or specialist is unavailable there, they are transferred again to a district hospital or other higher facility.
Red-category cases include conditions such as polytrauma, head injuries accompanied by loss of consciousness, ST-elevation myocardial infarction (STEMI), stroke, postpartum haemorrhage, eclampsia and respiratory failure. “The patient will be referred to a facility where the required linkage and clinical capabilities are available. Patients should not be unnecessarily transferred from one facility to another as per the prescribed referral hierarchy. The protocol adds that the emergency medical officers will be required to assess and stabilise patients before referral. “In critical cases, ambulance services must be activated, while the receiving hospital must be informed about the patient’s clinical condition and expected arrival time. The receiving facility will have to acknowledge the referral and communicate whether it can provide the required treatment,” it adds.
The referrals will be classified into three categories: red, yellow and green, according to the communication. If an intermediate facility does not have the required definitive treatment services, it may be bypassed as per the referral mapping,” says the SOP.
