Using geospatial techniques to develop an emergency referral transport system for suspected sepsis patients in Bangladesh

Abstract

BackgroundA geographic information system (GIS)-based transport network within an emergency referral system can be the key to reducing health system delays and increasing the chances of survival, especially during an emergency. We employed a GIS to design an emergency transport system for the rapid transfer of pregnant or early post-partum women, newborns, and children under 5 years of age with suspected sepsis under the Interrupting Pathways to Sepsis Initiative (IPSI) project.MethodsA GIS database was developed by mapping the villages, roads, and relevant physical features of the study area. A travel-time algorithm was developed to incorporate the time taken by different modes of local transport to reach the health complexes. These were used in a network analysis to identify the shortest routes to the hospitals from the villages, which were categorized into green, yellow, and red zones based on their proximity to the nearest hospitals to provide transport facilities. An emergency call-in centre established for the project managed the transport system, and its data was used to assess the uptake of this transport system amongst distant communities.ResultsFifteen pre-existing and two new routes were identified as the shortest routes to the health complexes. The call-in centre personnel used this route information to direct both patients and transport drivers to the nearest transport hubs or pick-up points. Adherence with referral advice was high in areas where the IPSI transport operated. Over the study period, the utilisation of the project’s transport doubled and referral compliance from distant zones similarly increased.ConclusionsThe GIS system created for this study facilitated rapid referral of patients in emergency from distant zones, using locally available transport and resources. The methodology described in this study to develop and implement an emergency transport system can be applied in similar, rural, low-income country settings.

Modelling improved efficiency in healthcare referral systems for the urban poor using a geo-referenced health facility data: the case of Sylhet City Corporation, Bangladesh

“…At the same time, it will be important to address some of the underlying private sector incentives or motivations behind the practice of referring complex or emergent cases to Osmani to evade responsibility for potential patient deaths [12]. The development of strong first aid and emergency transport systems and life support training are important first steps in ensuring that critical patients can be moved quickly and safely to facilities where their emergency needs can be addressed [21]. In the longer term, urban health systems planning should ensure that staffed and well-equipped emergency tertiary facilities be distributed throughout the city, to lessen patient flow to Osmani Medical College, and deal with emergent cases in a timely manner.…”

“…These reported data were not verified physically, nor were actual referrals tracked or the capacity of suggested alternative facilities assessed. It is also possible that other factors might affect the practicality of the "more efficient" referral options proposed here such as geographic barriers due to variable traffic conditions, lack of adequate transport, or socio-economic and cultural barriers [21,45]. Nevertheless, it seems reasonably safe to assume that shortest geographic distance should convert to lower travel times, especially where the difference in distance between current and alternative referral scenarios are larger.…”

“…According to the literature, referral systems that formalize communication and transport arrangements between different healthcare facility levels are especially important [18,21,22]. Indeed, the effectiveness of health delivery depends substantially on the efficiency of referral systems in minimizing delays in needed treatment by reducing travel time, identifying the closest appropriate provider [19,22] and supporting optimal utilization of the health workforce [18,20,23].…”

“…While referral systems are traditionally analysed from a patient-oriented, diagnostic process perspective [16,[23][24][25][26][27][28], in efforts to address inefficiencies in urban settings characterized by dense service provision and traffic, there is also merit in considering the geospatial dimension of referral. To date, several studies have investigated the use of Geographic Information Systems (GIS) to inform decision-making about interventions to increase access to emergency services [19,21,22,29,30]. In this paper, we explore the potential of GIS-informed modeling to support the development of referral networks for the urban poor that consider the geographic proximity of referral facilities, as well as service quality, hours of operation and costs.…”

“…An efficient referral system is especially crucial in the context of pluralistic health systems like Bangladesh, enabling a more systematic means of ensuring appropriate, timely, and affordable healthcare is available and accessible to the population [ 7 – 9 , 21 ]. Of particular concern are inefficiencies in referral from the primary contacts utilized by the urban poor (drug shops, traditional healers and consultation chambers etc.)…”