There is a referral shortage at Srinagar's tertiary hospitals
There is a referral shortage at Srinagar's tertiary hospitals

Oct. 8 in Srinagar: The healthcare system in Kashmir is still bogged down in a web of costs, despite Standard Operating Procedures (SOPs) and firm orders meant to stop the flood of unwarranted patient referrals to tertiary care facilities.

The persistent influx of referrals from the district and other healthcare facilities throws a frightening shadow over the efforts of Srinagar’s tertiary care institutions to provide people with high-quality treatment.

According to the health department’s estimated estimates, over 40,000 patients are sent from district hospitals and rural healthcare facilities to Srinagar’s tertiary care hospitals, adding to the load on these medical facilities.


Sher-e-Kashmir Institute of Medical Sciences (SKIMS) handles the bulk of referral patients, followed by Shri Maharaja Hari Singh (SMHS) Hospital, Lal Ded Hospital, and the Chest Diseases Hospital.

Concerns regarding the overburdening impact of unneeded referrals from sub-district and district hospitals have been raised by physicians working in these tertiary care facilities.

One senior physician at SMHS Hospital related a particular incident in which a district hospital sent a heart attack patient to a tertiary care facility owing to a scarcity of cardiologists caused by vacation leaves.

“Surprisingly, instead of limiting the referral to the critical case, all three heart patients admitted at the district hospital during that period were transferred to Srinagar,” stated the doctor.

A physician at SKIMS said, “Every day, we receive numerous patients who could be efficiently handled at sub-district and district hospitals, yet they continue to be directed to our facility.”

The expert stressed that while district and tertiary care hospitals have different amenities, over 30% of patients undergo unnecessary referrals and might alternatively get acceptable care at lower-level medical facilities.

The government has issued many circulars to address the problem of unwarranted referrals, but the reality on the ground has mainly not altered.

The physicians think that even if the government has made improvements to outlying hospitals’ infrastructure, more work is still required to get rid of the justifications for unjustified referrals.

To maximise healthcare resources and patient services across the system, the Health and Medical Education (H&ME) Department last year announced plans to examine all referrals from district-level hospitals to tertiary care facilities.

The government directive from 2022 states, “The Principal Secretary to Government, H&ME, has taken strong note of the referrals of patients from district health institutions to tertiary care institutions.”

It underlined the need to reduce inappropriate referrals since they place a heavy load on tertiary care facilities and underutilize district-level resources, including staff and infrastructure.

Dr. Mir Mushtaq, the spokesperson for the Directorate of Health Services Kashmir (DHSK), lauded the advancements made in the district’s and outlying hospitals’ infrastructure.

“Referrals cannot completely be eliminated, but they are being carefully examined by teams of physicians. Additionally, it is anticipated that referral cases will decline with the expansion of facilities at district hospitals and rural healthcare institutions, which will eventually benefit patients, “he noted.

According to a senior health department official, the main cause of these referrals is the dearth of certain experts and facilities in remote regions, which are difficult to build and maintain. The department is actively setting up MRI services at all new government medical colleges (GMCs) and district-level CT scan services, with results being sent through teleradiology. The purpose of this effort is to lighten the load on tertiary care facilities.



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