Bhubaneswar: In view of the Covid pandemic resurgence and the high and rapid rise of positive cases across the State, Additional Chief Secretary (Health) PK Mohapatra today issued a Standard Operating Procedure (SOP) to be adopted for referral of Covid positive patients across the districts.
Mohapatra has issued an advisory to all Collectors, Municipal Commissioners and CDM & PHOs in this connection.
The SOP intends to streamline the referral of critically ill patients to higher centres and to avoid the unnecessary overcrowding of patients at particular Covid facilities and also avoid the morbidity and mortality associated with the transportation of patients, the advisory said.
SOP For Referral Of Covid Positive Patients:
In view of the resurgence of Covid-19 high rise of patients, to manage the confirmed cases, each district has been equipped with Covid Facilities like Dedicated Covid Care Centers (DCCC), Dedicated Covid Health Centers (DCHC) and Dedicated Covid Hospitals (DCH) to prevent unnecessary movement of cases from one district to other so as to prevent community spread of the disease as well as decrease the load of such patients in one district. In order to prevent unnecessary crowding in certain Covid Facilities and to have a uniform patient load in different districts the following referral practice shall followed.
A. Referral System:
- The facility that starts the referral process is called the Initiating Facility, and they prepare an outward referral to communicate the patient’s condition and status.
- The facility that accepts the referred case is called the receiving facility.
- A back referral helps the initiating facility know what has been done which completes the referral loop between the 2 facilities. Its main goal is to improve and streamline communication among primary care physicians, secondary care specialists, and tertiary health care providers involved in a patient’s care. Ultimately, the aim is to improve the overall quality of care being provided by increasing transparency, reducing operational inefficiencies, and enhancing existing processes for healthcare organizations both large and small
- After the patient is cured it will be discharged as per the Government guidelines in force. The concerned district authority may take the patient and ensure home isolation as per the guidelines.
B. Referral mechanism inside a District.
(a) When a confirmed case is detected it shall be kept in an appropriate Covid faciiity like Covid Care Home (CCH) or Dedicated Covid Care Center (DCCC) when home isolation is not feasible. All the mild and very mild cases shall be kept only in such Centers and must not be kept in DCHC or DCH. Both the suspected and confirmed cases can be kept in such centers with separate arrangement for both so that no mixing occurs and may be allowed home isolation as per guidelines. It must be ensured that the oxygen saturation of patients is normal and for emergency, oxygen must be available in CCC for use till the patient is transferred.
(b) The Covid Care Centers and Covid Care Homes are mapped with a Dedicated Covid Health Center or Hospital. When a patient in a CCC develop symptoms it must be referred to a Dedicated Covid Health Center or Hospital which are designed for management of moderate cases with separate arrangement for suspected and confirmed cases. When a patient is detected with SARI or ILI like symptoms it must be placed directly in a DCHC instead of keeping in a CCC.
(c) When a case becomes severe in a DCHC or detected to be severe they can be placed in a Dedicated Covid Hospital which is designed for management of severe cases with HDU and ICU facility.
(d) In instances when there is no vacancy in a particular CCC or CCH of a district, the CCC or CCH in other districts in the cluster as enumerated in Appendix-1 shall be used for such patients till all the beds or facilities in the cluster districts are saturated or utilized. If the need arises for referring the patient to Covid-19 facilities of districts other than cluster districts, it may be done by maintaining due procedure as stipulated in these guidelines.
C. Referral mechanism between districts:
When the facilities inside a district are filled up or when a patient requires a higher care, the case, can be referred to a facility in their district after maintaining the following formalities
(a) The Authorised Medical Officer of the concerned Covid facility shall intimate the Collector and CDM&PHO of own district regarding the status of the patient and need for referral to a facility in another district.
(b) If permitted, the AMO of the initiating Covid Facility shall contact the Authorised Medical Officer to which the patient is to be shifted with intimation to the State Level Authorised Officer. The contact details of the AMOs will be notified in the appropriate WhatsApp group.
(c) Before shifting the AMO shall gather the following information
i. Nature/condition of the patient/stability of the patient for shifting.
ii. Assess the nature of treatment required.
iii. Decides the nearest possible Covid-19 Hospital to which the patient can be shifted.
iv. Contacts the Authorized Medical Officer of the receiving facility for availability of Facility (OT, Instruments, ICU, Ventilator etc) / Experts (Doctors) Equipment & Instruments required for proper management of the patient.
v. Assess the availability of appropriate Ambulance (ALS /BLS)
vi. When required the experts (Faculty of Pulmonary Medicine, Critical Care, O&G,, General Medicine, Orthopaedic, Neurosurgery, Psychiatry or any other faculty as per case) are consulted along with the State Level Authorized Officer.
(d). Finally if suitable the Authorized Medical Officer of the initiating and receiving facility prepare for sending and receiving the patient.
(e) Under no circumstances the patient of the initiating facility shall shift a patient
i.Without Informing the AMO of the receiving facility
ii. If bed is not available in receiving hospital.
iii. If the patient is not stable and
iv. If the patient is not fit to travel in Ambulance.
(f ) The documents like referral forms, copy of case sheet. Covid test result must be accompanied with the patient
(g) The AMO of the initiating facility shall intimate the time when the ambulance departed to the AMO of the receiving facility.
(h) The AMO of the receiving facility shall maintain a register regarding tentative arrivals of the referred patients and reserve the appropriate bed. It will prevent filling up of the bed by another patient while the ambulance reaches.
(i) The AMO of the receiving facility must ensure immediate admission of the patient and there shall not be any delay.
(j) After the treatment is completed the patient shall be shifted to the concerned initiating district for placing the patient in CCC or home isolation for another 7 days or as may be notified by Govt. from time to time in force and must be accompanied by details of treatment given.
D. Precautions before transfer:
(a) The detail vitals of the patient must be assessed so that the patient does not succumb on the way.
(b) Appropriate ambulance ALS/ BLS shall be used for such transfer.
(c) Patients on ventilator must be accompanied by an Emergency Medical Technologist or trained Pharmacist
(d) The near relatives or attendant of the patient shall be clearly informed regarding the condition of the patient, to which hospital it is referred, why it is referred and probable outcome of such referral so as to get full cooperation from them and reduce unnecessary anxiety.
E. Responsibilities of the Receiving Facility:
(a) After getting information of referral from the initiating facility, the AMO must initiate preparedness for receiving the patient as soon as the ambulance arrives.
(b) The patient must be immediately admitted and taken to the bed. If the patient is ambulatory then he/she shall be welcomed with snacks, juice and drinking water bottles.
(c) The near and dears or the attendants are to be counselled and they must be appraised regarding the patient at regular intervals.
(d) Must ensure other protocols regarding Infection Prevention Control measures, cleanliness, sanitization, good food etc. The AMO shall take measures to avoid any mismanagement and report accordingly.
Cluster Districts For Smooth Management Of Referral System