Obstetric Referral System during COVID-19 Pandemic: Tertiary Referral Hospital Perspective

Abstract

Objective: To evaluate the effectiveness of obstetric referrals to the dr. Cipto Mangunkusumo National Central General Hospital (RSCM), Jakarta, Indonesia, during the COVID-19 pandemic. Methods: This was a cross-sectional that compared the effectiveness of referrals before (July-December 2019) and during the COVID-19 pandemic (March-August 2020) at the National Central General Hospital dr. Cipto Mangunkusumo (RSCM). Referral effectiveness is assessed based on two criteria, namely the suitability of the diagnosis and procedural compliance which includes communication through the integrated emergency response system (SPGDT), delivery by ambulance, and attachment of a referral letter. Results: The study found 198 referral cases from 464 obstetric cases (42.67%) before the pandemic and 231 referral cases from 486 obstetric cases (47.53%) during the pandemic. The diagnostic concordance increased from 57.58% before the pandemic to 71.00% during the pandemic (p = 0.004). Referral procedural compliance increased from 28.28% before the pandemic to 45.45% during the pandemic (p < 0.001). Based on these criteria, the effectiveness of referrals at the RSCM during the COVID-19 pandemic era was found to be significantly higher, namely before the pandemic by 21.72% and during the pandemic by 40.26% (p < 0.001). Conclusion: The effectiveness of referral to the RSCM based on the suitability of the diagnosis and the accuracy of the procedure during the COVID-19 pandemic was found to be better than before the pandemic.