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Govt issues revised guidelines on ‘level 2’ to ‘level 3’ referral

In light of the rising fatality rate, the state health department has once again reminded government and private hospitals of the protocols for referring a patient from ‘level 2’ (critical) to ‘level 3’ (very critical, ICU).

Written by Raakhi Jagga | Ludhiana |
Updated: August 27, 2020 11:55:25 am
Govt issues revised guidelines on ‘level 2’ to ‘level 3’ referralIn light of the rising fatality rate, the state health department has once again reminded government and private hospitals of the protocols for referring a patient from ‘level 2’ (critical) to ‘level 3’ (very critical, ICU).(Representational)

A total of 792 Covid patients have died in Punjab hospitals between August 1 and 25. The toll shot up from 386 on July 31 to 1,178 till August 25. Based on these figures, an average of more than 30 Covid patients are dying in the state each day.

In light of the rising fatality rate, the state health department has once again reminded government and private hospitals of the protocols for referring a patient from ‘level 2’ (critical) to ‘level 3’ (very critical, ICU).

“Though referral protocols existed since the start, we have sent them again to all hospitals.We have observed that at times, there is a delay in referring patients from level 2 to level 3 or the patient comes from his/her house very late. So the doctor needs to decide on which level he/she should be admitted straight away,” said Dr Rajiv Bhaskar, nodal officer of Covid cases in Punjab.

Meanwhile, on almost a daily basis, relatives of patients are raising their voices in the event a patient dies. Such protests are even sometimes even held on hospital campuses.

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Revised guidelines were issued on August 24 which lay down parameters under which a patient should be referred from a dedicated Covid health centre (DCHC) to dedicated Covid hospital (DCH) i.e from level 2 to level 3.

These include: if oxygen concentration decreases below 90 per cent at room temperature, if there is respiratory distress, abdominal paradox, of pulse rate is more than 120 per minute, of blood pressure falls to 90/60 mm/Hg,, urine output decreases to less than 150 ml in 6 hours, patient is confused/ drowsy, has high grade temperature, neutrophil/ lymphocytes (white blood cells to build immunity) are more than 3.5.

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The protocol says, “Referral teams can make their own clinical judgement as per facilities available at their institutes. They must keep in mind the time taken for shifting a patient from level 2 to level 3 hospital, prior coordination must be done with concerned hospitals before referring a patient to level 3.”

Moreover, a referral form must be signed by a senior medical officer of level 2 facility, anesthetist or doctor in charge at DCHC. Though referral protocol says that trained paramedical staff must be in an ambulance along with a patient, most of the time, patients’ attendants take them from one centre to another on their own.

When contacted, Dr Sandeep Sharma, medical superintendent of Dayanand Medical College and Hospital, said, “Patients who keep on self medicating at home, at times come very late and hence their relatives are not able to understand the loss of time while sitting at home. Thus they lose their time of shifting from level 2 to level 3.”

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At the same time, it was revealed that a number of patients from civil hospitals get shifted to tertiary care hospitals in Patiala or other centres very late, often leading to death.

In Punjab, a total of 44,577 cases were recorded till August 25 and 1,178 had died. The case fatality rate of state was 2 per cent on July 31, which has now increased to 2.6 per cent. In many districts like Sangrur, Ludhiana and Amritsar, it is over 3.5 per cent.

Till August 25, 792 deaths have taken place, of which 331 took place in private tertiary care units while the remaining 461 took place in government medical colleges or civil hospitals.

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First published on: 27-08-2020 at 11:46:02 am

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