Quality of referral to the pediatric emergency of a tertiary care hospital in a developing country before and after introduction of an educational interventional module E

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Background : Since there is no standard referral and feedback system available in India, we decided to study the quality of referral coming to our Pediatric Emergency before and after the introduction of an educational module with respect to demography of referral, association with severity of illness, mortality and feasibility issues. Using this data we plan to develop a standard referral format and feedback system that will help in streamlining the emergency referrals Methods : Methodology: Our study was completed in three phases in the Paediatric Emergency Unit viz the Pre intervention data collection, Intervention Phase, Post intervention data collection Quality of referral were done using structured referral proforma and comparative statistics were done for various parameters Results : A total of 1249 patients attended emergency during the pre and post intervention phases of which 4864 patients were admitted, 2359(48%) were paediatric and 2472(51%) were neonatal referrals. Thus our major chunks of inpatient admissions were ‘referred’ patients (99.3%). The two neighbouring states of Punjab (48.2%) and Haryana(22.4%) were topping the list. 80.9% referrals were from public sector hospitals of which the medical college hospitals topped the list (53.6%). 86.4% used Government ambulance services. Most common cause of referral was PICU/NICU/Mechanical ventilation (50.4%) The quality of referral had an association in terms o physiological status at the time of arrival. The proportion of patients arriving in the decompensated status in relation to poor referrals had significantly decreased in comparison of pre and post intervention period [580(79.8%) vs 1025(93.7%); p=0.0001]. The proportion of poor referrals had significantly reduced to 78% and there was a corresponding significant increase in proportion of fair (18%) and good referrals (4%). Conclusion : Referral education interventional module had significantly improved the quality of referrals coming to our Pediatric emergency in terms of better apre referral documentation of investigations, examination findings, and reasons for referral. The proportion of patients presenting in a decompensated state had significantly reduced after introduction of interventional module. Continuing education will be required for sustained and increasing benefits. There is a need for structured referral proforma and referral network among the healthcare facilities in the particular geographic area.