Allow me to share here the speech I gave during the Plenary Session for POGS Organization of Government Institutions and the POGS Service Delivery Network for the 2024 POGS Annual Convention and 78th Anniversary Celebration on November 15, 2024 at the PICC.
I greet everyone from the queen city of the south,
Cebu. To provide context, I am a medical
specialist from the regional tertiary referral hospital Vicente Sotto Memorial Medical Center.
GOVERNMENT HOSPITALS INUNDATED WITH PATIENTS
The photo shows the situation back in 2015 when our 6-bed
labor room accommodated more than 60 parturients. Imagine that the next patient would simply be
offered that empty stool while in labor.
Just like other government hospitals, we were inundated with patients.
In May 2015, our
training officer Dr Helen Amorin assigned me to review the maternal mortality
reports for the month in preparation for the POGS Cebu quarterly maternal
M&M conference. There are 31 days of
May and I was shocked to discover that we had 29 maternal deaths for that
month. Naturally, during the M&M
conference, one of our POGS luminaries demanded that “since there are
soooo many maternal deaths, we should investigate this hospital!”
This is because when patients are for emergency CS,
they refer to Sotto. When the patients
have financial constraints, they refer to Sotto. When patients are in critical condition, they
refer to Sotto. Every ambulance that
transports each patient seems to shout “Sotto!
Sotto! Sotto!”
This is where it all began.
PERINATAL STATISTICS
In 2016, our perinatologist Dr Kristina Dosdos started
a joint conference between the Department of Obstetrics and Gynecology and the
Department of Pediatrics called the Perinatal
Statistics. We noted that
·
more than 40% of our
admissions were low risk pregnancies, which could
be managed at primary and secondary level facilities.
·
One of our former residents Dr
Princess Lorezo conducted a research on decision to delivery interval. Turn around time for cesarean section delivery is more than
12 hours on average!
MATERNAL PERINATAL STATISTICS
In 2017, we started the Maternal Perinatal Statistics,
inviting the City Health Officer and the Cebu Provincial Hospital to listen to
our data presentation in the hopes of finding solutions.
QUARTERLY MATERNAL PERINATAL STATISTICS
By 2018, we started the Quarterly Maternal Perinatal
Statistics where all government hospitals present their accomplishment reports,
census of referrals and maternal and perinatal deaths. We would also flash the top ten referring
facilities!
NO ONE HOSPITAL CAN DO IT ALONE
Allow me to mention to acknowledge their contribution
to the success of this endeavor the anatomy of Cebu HealthCare Provider Network
- CEBU – 1 apex DOH hospital, Vicente Sotto Memorial Medical Center
- 3 DOH hospitals - Eversley Childs Sanitarium and
General Hospital, Saint Anthony Mother and Child Hospital and Cebu South
Medical Center
- 4 Cebu provincial hospitals – CPH Bogo, CPH Danao, CPH
Balamban and CPH Carcar
- 3 city hospitals – Lapulapu City Hospital, Mandaue
City Hospital and Cebu City Medical Center
- There are also 12 district hospitals and 5 apex
private hospitals.
With the key message that “NO ONE HOSPITAL CAN DO IT ALONE!” The problem was the high maternal mortality
in Cebu, most dying in VSMMC. So
the objective of the Quarterly Maternal Perinatal Statistics was to assess and
develop strategies to strengthen the referral systems in order to reduce
maternal and perinatal mortality in Cebu:
1.
Create technical working group that
meets during quarterly maternal-perinatal statistics agreeing to a NO-BLAME
culture
2.
Establish the real-time online
referral system
3.
Improve functionality of peripheral
hospitals to schedule elective CS at their convenient time.
4.
Develop agreements on two-way
referrals for the implementation of the Central Visayas Health Referral System
Most of the complaints of the hospitals were
difficulty contacting VSMMC telephone line to refer, lacking manpower, no
computer and internet connections. I distinctly remember that it was Dr Mona Yiu who demanded
for a real time communication system between hospitals. The hospital chiefs were convinced to find
ways to decongest VSMMC in order to allow us to accommodate more of their
patients needing tertiary, critical and intensive care.
ELECTRONIC REFERRAL SYSTEM
It was the DOH Central Visayas Center for Health
Development that was successful in developing a program for the electronic
referral system following guidelines in the Central Visayas Health Referral
System Manual.
I am glad that Dr Joy Novero presented that this
system is being used even in private hospitals like UCMED. Dr Veloso was one of the representatives of
POGS Cebu during the QMPS.
But having the technology is not enough, because we
need buy in of the end users.
Pag ayaw, may dahilan.
What did we do?
VSMMC as the tertiary referral hospital stopped tolerating. We get what we
expect. We deserve what we tolerate. We stopped accepting walk-in patients. We stopped accepting patients who were not
referred thru the electronic referral system.
We stopped accepting patients who were low risk.
It needed POLITICAL WILL AND GOOD GOVERNANCE. We were fortunate to have genuine humanistic
leadership in the person of our BIG BROTHERS Dr
Gerardo M Aquino Jr, our medical center chief and Dr Jaime Bernadas, our DOH Regional Director.
Gone are the patient referrals “TO HOSPITAL OF
CHOICE” For referral of patients from
hospitals, we utilize the Central Visayas electronic
health referral system. For
referral of patients who are at home in emergency situations who need transport
to the nearest available hospital, we have the DOH
711 emergency healthline.
Currently, our DOH7 is working on developing the Telemedicine Program
for electronic health records across all government health facilities with
interoperability.
COVID19 PANDEMIC
This strong working relationship between our hospitals
in the Service Delivery Network and HealthCare Provider Network was sorely
tested during the COVID19 pandemic. Dire
need mandated compliance with the electronic referral system guidelines. With the systems in place, we were able to
provide more beds for severe and critical COVID19 patients at VSMMC.
This year, the technical working group for the
healthcare provider network crafted the guidelines for referral based on
functional capacity of health facilities.
The DOH Central Visayas Center for Health Development released a
memorandum on the levels of care with different diagnosis and cases to guide
decision-making on who to refer, when to refer, where to refer and which cases
should be prioritized for referral to VSMMC as the tertiary end-referral
hospital. No matter if the doctors argue
online, at least the patient is in a hospital that can provide monitoring and
care. All for patient safety.
IMPACT on BETTER HEALTH OUTCOMES, STRONGER HEALTH
SYSTEM, ACCESS TO ALL LEVELS OF CARE
In 2017, Dr Dosdos reported that we had 95 maternal
mortalities that year.
In 2020, we had 60 maternal mortalities.
By 2023, we were down to 31 maternal mortalities for
the whole year, less than 1% of all admissions.
Today, if you need to be admitted, you don’t need to
know anyone to have access. You might
need to wait, but eventually you will be accommodated. The DOH 711 emergency healthline and the
electronic health referral system will help make sure that THE RIGHT PATIENT
IS AT THE RIGHT FACILITY AT THE RIGHT TIME ALL THE TIME.
Kay kami sa Sotto, kalidad nga serbisyo
among garbo.
Quality service is our pride.
