A RETROSPECTIVE STUDY TO DETERMINE THE EFFECT OF “REFERRAL-IN” ADMISSIONS ON THE FUNCTIONING OF GYNECOLOGY & OBSTETRICS DEPARTMENT IN A TERTIARY CARE HOSPITAL OF NORTH INDIA.

Introduction: Regionalization envisages a two-way ow of patients & services designated as “Referralin” and “Referral-out” cases.”Referral-in” generally means patients from Sub Center, Primary Health Center, Community Health Center & District Hospitals Referred to Tertiary Care Hospital for Specialized care.”Referred-out” Generally means patients from Tertiary Care Hospitals to Higher Centers like Apex Institutions including AIIMS (New Delhi),SKIMS(Srinagar).PGIMER(Chandigarh, SGPGI(Lucknow), etc. for Super specialized treatment. Objective: To determine the effect of Referral- in admissions on the functioning of Gynecology & Obstetrics Department in a Teaching Hospital. Methodology: An Observational study was conducted over a period of 12 months from February 2019 to January 2020 in a 750 –bedded Tertiary Care Hospital of Jammu(UT) popularly Known as Shri Maharaja Gulab Singh(SMGS) Hospital, Jammu. Observations & Results: A detailed description of academic as well as functional status of Gynae & Obs. Department including Faculty-position, OPD patients, Inpatients admitted, Deliveries conducted(LSCS & MLE), Surgical Operations(Major as well as Minor) along with Bed-Occupancy Rate(BOR) & Referred-in Admissions during the study duration was recon ciliated & put forth in Tabulated Form after collecting from the Medical Records Department of the Hospital & displayed Statistically in Bar-Charts & pie-Chart. Discussion: Excessive Referral-in admissions to Teaching Hospital from PHC,SDH,DH & AH Level results in Overcrowding/Congestion in Hospital Wards culminating in Exhaustion of Resources like Drugs, Medicines, Reagents & other logistics. Supportive Services like Sanitation, Ambulance Transportation & Dietary facilities get worsened thereby exaggerating the Sepsis as well as nasocomial infection rate. There are increased chances of Corruption, & Violence/Verbal Scufes between Hospital Staff & Attendants of patients. Conclusion & Recommendation: Instead of irrationally referring the patients to Teaching Hospitals from Lower level Health Care Facilities(HCF), they should be rst sent to Associated Medical College Hospitals established at different Districts before being referred to Provincial Tertiary care Hospital thereby reducing the extra-load over Teaching Hospitals resulting in rapid depletion of resources as well as Medico- Social and Law & Order problems.