Substandard referral systems adopted by peripheral healthcare centres and private hospitals have put newborns and children under five at risk and led to mortality, according to research conducted by a team of doctors at Safdarjung hospital.
The research was conducted by doctors to study risk factors predicting mortality within 48 hours of admission in newborns and children under 5, referred to the paediatric emergency of a tertiary care hospital in India.
According to the research, 20% of 246 consecutive paediatric referral cases (62 newborns, 52 infants, and 132 children aged between 1 and 5 years) enrolled at Safdarjung Hospital witnessed mortality within 48 hours.
As many as 300 children were enrolled in this study. Out of these, 246 referred children were included for analysis and 54 were excluded. The children who were excluded were those who had come for surgical cases as the researchers were only looking for children of medical cases.
According to the research, 60% were referred from one healthcare contact, whereas 40% had to visit two and more healthcare facilities before being referred. Sixty per cent covered more than 20 km during transport and 20% of patients took more than two hours to reach the hospital. “Indication for referral to our centre was lack of intensive care services,” the study said.
The team found that financial constraints were a leading cause of referrals from private hospitals.
“A large percentage was also referred from public sector hospitals. A majority (60%) referrals were due to unavailability of intensive care services, while a third was critical at arrival, requiring immediate resuscitation and management,” said the study.
The research concluded that developing a paediatric triage and monitoring system, telepaediatric ICU, regionalising referral and back-referral services with robust interhospital communication, and strengthening paediatric emergency services are the need of the hour to reduce early in-hospital mortality.
One of the contributors to the research, Dr Harish Chelani, Professor at Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, said that tertiary care hospitals like Safdarjung hospital are loaded because there is no prior referral information.
“We are not informed about the patients in advance. The babies are coming from peripheral healthcare centres and private hospitals and different states of the country in unstable conditions. Since Safdarjung Hospital has a non-refusal policy, they have to be taken up,” he added.