The Delhi government is contemplating a policy to streamline the flow of patients from smaller hospitals to bigger centres, after rising complaints from hospitals about “basic” cases being referred to their centres. At least three Delhi government hospitals with 500 beds or more have complained to senior health department officials and the health minister in the last month over the issue.
Sources said departments like gyanecology and surgery have been most commonly found to be referring a high number of cases. “In one hospital, the gynaecology department said a maternity home under the civic body was referring bulk of its patients to this hospital. A smaller Delhi government hospital was also referring a lot of cases here,” an official said.
In the second hospital, doctors from both surgery and gynaecology pointed out that most of the referred cases can easily be managed by these hospitals.
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In the third, doctors have said the surgery department is receiving a large volume of referred patients, which leads to overcrowding and long waiting lists. In the three departments of surgery, orthopedics and gynaecology, doctors at the larger hospitals said they already have to make patients share beds.
Last month, in a review meeting, pictures of the gynaecology department of a smaller Delhi government hospital were shared. The hospital, with around 200 beds, had put up a notice outside its operation theatre listing out a series of gynaecological problems that warranted referrals to higher centres.
“These included common conditions for which anybody seeks medical help. When the hospital authorities were asked about the need for referring these patients, they listed out a variety of problems including poor infrastructure maintenance. In a lot of conditions, doctors referred patients due to their inability to make a correct diagnosis, without investigation,” the official said.
Doctors in advanced tertiary hospitals said an analysis of referred patients showed that referrals were made without any medical reasons in referral papers.
“There is no identified condition in most of their papers so, first, doctors with strained resources have to take the history from the patients,” a doctor from an aggrieved
At the smaller hospitals, doctors complained of lack of functioning machines or shortage of beds, she added. “Patients are sent with only the ambulance staff, and no referral hospital identified. Due to the areas identified for each ambulance, the bulk of referrals come to particular hospitals. There is no system of distributing even the patients who need advanced care uniformly,” a doctor explained.
The Delhi government, after meetings with medical superintendents held over the last month, is contemplating a detailed referral policy.
“We are considering directing all hospitals to identify supervising officers for referrals. They will be senior doctors who will ensure medical justification in all referrals. The referral in-charges in larger hospitals will also be responsible for ensuring timely treatment of patients sent from smaller hospitals,” the official explained.
He said guildelines will be issued to hospitals on conditions which warrant referrals and the necessary details to be mentioned in referral papers so that patients can be treated immediately.