HOSPITAL QUEEN ELIZABETH Karung Berkunci No. 2029 88586 Kota Kinabalu Tol: 088-5175 SABAH, MALAYSIA Faks : 088-211909/319605, Laman Web: hitpsigeh.moh.govmy No. Rujukan : ( 14) HQE.600-3/24 Jid 2 Tarikh a YA pril 2022 Ketua Penolong Pengarah, Jabatan Kesihatan Negeri Sabah U/P : Dr Jonathan Lamit Tuan, MAKLUMAN CARTA ALIR SOP PROSEDUR RUJUKAN DARIPADA HOSPITAL DAERAH DAN HOSPITAL SWASTA KE HOSPITAL QUEEN ELIZABETH, KOTA KINABALU. Dengan segala hormatnya perkara tersebut diatas adalah dirujuk dan hasil perbincangan Mesyuarat Semakan Mortaliti Penyakit Berjangkit JKNS Bil 02/2022 yang diadakan pada 14/4/2022 adalah berkaitan. Untuk makluman pihak JKNS, dalam Mesyuarat Semakan Mortaliti Penyakit Berjangkit di peringkat HQE pada tahun 2019 dan 2022, terdapat 2 kes yang mana kelemahan pengurusan kes melibatkan pesakit yang dirujuk daripada Hospital Swasta ( Gleneagles Kota Kinabalu ), dan terlantar lama di Jabatan Kecemasan & Trauma sementara menunggu katil di Unit Rawatan Rapi 1) Kes 1 Punca Kematian : Septic shock with severe Melioidosis complicated with transaminitis, AKI, thrombocytopenia, hypoglycaemia and severe SRDS. Masa menunggu di Jabatan Kecemasan & Trauma : 4 Jam 2) Kes 2 Punca Kematian : Tetanus from infected left 5" toe wound Masa menunggu di Jabatan Kecemasan & Trauma : 19 Jam Panel mesyuarat berpendapat bahawa rujukan seharusnya dibuat secara terus ( direct referral ) dengan pihak Unit Rawatan Rapi ( Pakar ) supaya persediaan untuk menerima pesakit dapat dibuat dengan segera. Pesakit juga hanya boleh dipindahkan daripada Hospital Swasta / Daerah apabila Unit Rawatan Rapi sudah bersedia untuk menerima pesakit. Masa pesakit menunggu di Jabatan Kecemasan & Trauma adalah terlalu lama dan rawatan pesakit mungkin terjejas ( suboptimal ) memandangkan keadaan pesakit yang tenat. ___ Sebagai tindakan penambahbaikan, Carta alir SOP Prosedur Rujukan Pesakit Daripada Hospital Daerah dan Swasta telah dibentangkan dan diluluskan pada Mesyuarat Medical and Dental Advisory Committee Bil 02/2020 bertarikh 3/7/2020. Dilampirkan bersama carta alir Standard Operating Procedure for Referral From District / Private Hospital untuk rujukan tuan dan edaran kepada hospital daerah dan swasta “°KAMI SEDIA MEMBANTU” (Sila catatkan rujukan surat hospital ini apal‘Sekian, terima kasih. “WAWASAN KEMAKMURAN BERSAMA 2030” “BERKHIDMAT UNTUK NEGARA” Saya yang menjalankan amanah, NOR, WILLIAM Pe GOTULIS ox) {to2ptal Quen Elza MPM No Pendattaran Rerwn: 31715 Hospital Queen ElizabethLampiran 4 Standard Operating Procedure for Referral From District/Private Hospi In-patient or patient rom other hospital (Dstrct/Private)requies transfer ram Ditrit Prate Hospital Refer tPrimary Care team in HOE ‘Stabilize and vansfer to HO |e scission a4 HOW cL / Wards lnform peripheral anaesthesia MO on atv 10 set the ventlator Primary tearm HOE to inform EP and to refers Patipheral Anaesthesia MO oneal ‘Resuscitation &stabilzation by primary team and ETD Follow SOP chart for Standard Operating Procedure for Mechanica Ventatr/ Cet are Bed Referral From Ditiet/Prvte Hoeptal Disposition (alive) ee Merson to ai no wncur wards Mortuary Stable patients should be directly admitted to the ward/ICU/HDW a. Intubated/Non-intubated. b. Donot require resuscitation. 2. ICU patient transfer should be discussed with ICU specialist and primary team is responsible to allocate the bed/ ventilator. (Pekeliling Ketua Pengarah Kesihatan Bil 2/2009: Paragraph 1, Page 15) 3. Ifpatient not stable a. Primary team must inform Emergency Physician. b._Primaty team together with ETD team will conduct resuscitation of the patient ‘and decide for disposition. Referral to other team must be done as soon as possible before disposition of patient to ward or ICU. 4. Duration of patient in ETD should be < than 1 hour if the patient able to successfully revived. ¢. Polytrauma patient and patient with major organ injury has to be reviewed in ETD. Should the patient deteriorate during transfer, upon arrival must be resuscitated at ETD. If they are no available beds in HE for transfer, the Private hospital have to keep the patient and manage the case until bed is available. 6. Private Hospital needs to refer unstable patient to HQ if there is no primary team in their setting to manage the case.