A pilot project of a patient referral system for government hospitals in Bengal has shown that once patients are referred to a healthcare facility away from home, many do not go there, state health department officials said.

Most patients are “missing in transit” and health officials feel they either visit a private facility or turn up at a smaller government hospital nearby. Some do not get any treatment at all.

The state government had on October 15 launched the pilot project for the central referral system, which ensures that a government hospital refers a patient to another state-run facility only if the latter has a vacant bed and the facilities to treat the patient.

An official in the state health department said the system would be rolled out in north Bengal on Sunday. A training session will be held on Saturday for the roll-out.

The government plans to include private hospitals that treat patients under the Swasthya Sathi scheme in the system.

The referral system was one of the 10 demands of the junior doctors who have been protesting against lapses in the government-run healthcare system in Bengal since the rape and murder of one of their colleagues at RG Kar Medical College and Hospital on August 9.

The junior doctors have said that patients’ family members or acquaintances often get angry and assault doctors because they are unable to ensure admission.

In the pilot project, MR Bangur Hospital, Calcutta National Medical College and Hospital and SSKM Hospital are the destination hospitals for referrals.

Since October 15, more than 100 patients have been referred to MR Bangur Hospital from government hospitals in South 24-Parganas. Of them, most did not come to MR Bangur for admission, officials said.

“Very few patients turned up at MR Bangur Hospital after being referred. We think there are social and other reasons for that,” said an official.

“One reason can be the location. Patients from remote places in South 24-Parganas find MR Bangur, which is in Tollygunge, too far. They need to hire an ambulance, which costs a lot of money,” the official said.

“We think such patients are getting admitted at nearby private nursing homes under Swasthya Sathi.”

A public health expert said there could be other reasons, too.

“A patient needs to be accompanied by one or two persons, who are often daily wage earners. Accompanying a patient may cause a loss of a day’s earnings. So such patients prefer to get admitted to a facility near home,” the expert said.

“There is a need to upgrade the facilities at smaller government-run hospitals to
address this problem. The high number of referrals in around 15 days shows how inept the peripheral healthcare system is.”

This is the first time details of a referred patient are being recorded in the health department’s system.

“Earlier, there was no way to know what happened to a patient once he or she was referred from one hospital. Now, we could see whether the patient is getting a bed at the referred hospital or not,” said a health department official.

Once a patient is referred from a government hospital, he or she is handed a green slip. The slip has to be shown to doctors at the destination hospital.

In the new system, a doctor has to log into the portal ofthe health department’s health management information system while referring a patient.

The doctor will receive options from among the hospitals where the patient’s ailment can be treated and a vacant bed is available. Once the doctor enters the patient’s details and refers him or her to another government hospital, the destination hospital will provide a token number.

“If the hospital where the patient has been referred to does not respond to the message on the portal, the patient will automatically be allocated to that hospital after 30 minutes,” said an official.

However, the new mechanism cannot find out where the patient is going if he or she fails to turn up at the referred hospital.

“We expect that once the referral system becomes operational throughout the state, people would get more choices near their homes. Also, we will approach private hospitals to get included in the referral chain and treat those patients under Swasthya Sathi,” said a health department official.“Some private hospitals may be reluctant to be included in the system but we will try to sort out the problem.”