New Delhi: A recent order issued by the government has cited significant anomalies and lack of accountability. Referral ProcessOrganization Ministry of Health has been issued for the first time Interdepartmental Referral Guidelines For hospital To facilitate better communication and collaboration. The ‘Guidelines for inter-departmental referrals (within hospitals)’ emphasise that referrals should be initiated promptly whenever patients require specialised care, diagnostic assessment or consultation beyond the scope of the admitting department.

Referrals for consultant opinion should only be written by Consultants The guidelines, issued on June 7, state that postgraduate residents should not turn down self-referrals without discussing with their consultants.

The consultant on call should review the referral records seen by his team the previous day, a step that will help improve Patient Care and promote education of residents.

Dr Atul Goel, Director General of Health Services, Union Health Ministry, said in the document that the referral process is a vital component of high-quality patient care in any medical institution.

Dr Goyal said problems such as poor coordination and communication, unclear processes, non-standardised formats and inadequate training for healthcare professionals are common and can ultimately lead to patient harm.

He said that the roles of different professional levels are often undefined, resulting in gaps in patient care. He highlighted that many patients visiting hospitals suffer from multiple co-morbidities and require a multi-disciplinary approach.

The document states that a strong and efficient referral mechanism should also be an essential part of the training of residents. This training will be very useful for them when they enter the healthcare setup to practice after residency.

However, problems can arise in any inter-departmental referral process, including delays in the referral process/attendance, breakdowns in communication, and variations in referral practices across departments.

To address these challenges, hospitals must implement standardized referral protocols, streamline referral workflows, and provide education and training to healthcare providers and staff involved in the referral process.

“Currently, with no clear guidelines in place, it has been observed that there is diversity in the referral mechanism. Each department and individual has their own way of sending and attending to referrals. The documentation is also variable and inconsistent.

“There is a delay in attending to referrals, which may adversely impact patient care. Most junior residents (first or second year post-graduates) receive referrals that require a higher level of input. There is conflict between departments over referrals, often due to lack of communication,” the document says.

The guidelines state that departments may prepare a roster with the names of officials in various units, contact numbers and availability of the units on various days, time and place where referrals need to be sent.

It should be available on the website and also disseminated within the institute.

Referrals should help in patient management, without burdening the referring department with a huge list of investigations. The guidelines state that any investigations performed by the referral team should be fully justified by the given diagnosis.

The guidelines state that referrals should be documented accurately and comprehensively, including relevant clinical information, expected outcomes from the referral, patient preferences, and other specific instructions.

It states, “Communicate clearly and effectively with receiving departments, providing necessary clinical information and patient context to facilitate appropriate assessment and management.”

The guidelines emphasized following up on referrals and coordinating care transitions, and ensuring that patients received necessary follow-up appointments, treatments, and interventions.

It also calls for seeking feedback from referring providers and receiving departments to identify areas for improvement, increase the efficiency and effectiveness of the referral process, and prioritize patient-centered care by considering patients’ preferences, values, and treatment goals in the referral process and treatment planning.

Among the don’ts, the guidelines say, is do not delay referrals unnecessarily, as this can impact patient care and lead to adverse outcomes.

The guidelines state, “Do not omit essential clinical information or documentation when initiating a referral as this may impede the receiving department’s ability to provide appropriate care. Do not assume that all referrals are routine or non-urgent; carefully assess each patient’s clinical presentation and urgency to determine the appropriate level of priority.”

“If there are delays or barriers to the timely referral process, do not hesitate to pursue an urgent referral or seek assistance from senior colleagues or hospital administrators,” it says.

The document states that special circumstances may arise during the follow-up of a referral that require special attention and handling, for example if a referral is rejected by a specialist or receiving department, the referring department should be informed of the reasons for such rejection along with alternative options of care.

It states that if a patient fails to attend a scheduled referral or is not in bed, the patient/treating team should be contacted to ascertain the reasons for absence and to address any barriers or concerns.