A Study of the Assessment of Hospital Referrals before Death amongst Cases Coming for Autopsy at a Tertiary Care Hospital

Background and justification: With an overall increase in the global burden of diseases leading to increased morbidity and mortality, there has been an ever-growing demand of more manpower in the health sector. With increasing demand for specialty-based care and limited resources to meet the demand, an effective and efficient referral system is essential. Objectives: The study has been done to estimate the number of referrals in relation to the cause of death, to find out the number of cases with referrals in between tertiary care centres and to estimate the distance between the initial health centre and the hospital where the death is occurring. Methodology: It was a retrospective autopsy record-based study of 1 year duration in which cases where there were at least one or more than one referral during the course of treatment were taken. Cases where there was inadequate information regarding hospital referrals, brought dead cases and cases where the patients left against medical advice during the course of treatment were excluded. Results: 125 cases of head injury, 129 cases of polytrauma, 79 cases of burns, 105 cases of poisoning and 118 other cases were referred to four different hospitals. In 520 cases, the distance between the initial health centre and the last hospital where the patient died was 151-200 kilometers. Conclusion: An increase in hospital referrals while aiming to provide necessary care can paradoxically contribute to mortality if not managed effectively.