PATNA, July 13 -- The state health department issued detailed operational guidelines directing district and sub-divisional hospitals to strictly regulate patient referrals to higher centres, including medical college hospitals. strengthen specialist consultations and ensure digital documentation of every referral through the BHAVYA portal, an integrated digital health platform that enables hospitals to maintain electronic health records, register patients, manage OPD/IPD services, record referrals, and facilitate seamless sharing of patient information across government health facilities, thereby ensuring continuity of care and improved monitoring, state health department officials said on Sunday. The directive, issued on July 10 by Bihar's health secretary Kumar Ravi to the district magistrates, civil surgeons and chief medical officers, aims to curb avoidable referrals and ensure that patients are shifted to higher centres only when treatment is unavailable at the referring facility. Under the new protocol, district hospitals have been instructed to refer patients requiring super-speciality care only after evaluation by the specialist concerned, while referrals from sub-divisional hospitals to district hospitals or medical colleges must be made only when the required speciality or treatment is unavailable locally. Hospitals have also been directed to ensure that all available diagnostic and treatment facilities are exhausted before referring any patient. The circular makes it mandatory for every referral to be digitally recorded on the BHAVYA portal, with complete clinical details, investigations and treatment history uploaded to facilitate seamless continuity of care. Hospitals have also been directed to generate or link the patient's Ayushman Bharat Health Account (ABHA) number and maintain electronic health records (EHR) for all referred patients. This will automatically create and update the patient's electronic health record (EHR) in their ABHA, enabling its effective use for future medical treatment, the circular added. The guidelines said that patients arriving for treatment in the IPD, accident (trauma) and emergency departments should be provided prompt initial treatment and necessary investigations without any procedural delay. The health department further instructed all district and sub-divisional hospitals to operationalise the in-patient department (IPD), trauma and emergency modules of the BHAVYA portal and ensure timely data entry. Referral details, reasons for transfer and receiving institutions must be accurately documented to enable monitoring and accountability. Before referring a patient, the superintendent or the deputy superintendent or the in-charge of the health institution concerned must ensure that the required medical facility for the patient is not available at that institution. In case of referral, it will be mandatory to clearly mention the reasons for referring the patient. In case of referral, the complete patient journey of the concerned patient should be properly documented, and a computerised copy of the same should be provided to the patient. In emergency situations, arrangements should also be made to send it to the patient/attendant on their mobile phone, the circular stated. In case a patient is referred, the patient should be stabilised and sent through a government ambulance (advance or basic life support ambulance) after making the necessary arrangements. The circular also said that under no circumstances shall there be any unnecessary delay in referral cases. The in-charge medical officer and hospital manager of the health institution will be held responsible for any kind of procedural delay, the circular added. Civil surgeons have been directed to ensure strict compliance with the referral protocol, while district authorities have been asked to monitor implementation and submit regular reports to the department. The guidelines follow Bihar CM Samrat Choudhary's recent announcement that a statewide referral policy will come into force from August 15 under which patients would be referred to higher healthcare facilities only in cases where treatment is genuinely unavailable at the existing level. The policy intends to reduce unnecessary referrals, improve utilisation of district and sub-divisional hospitals and ease the patient load at tertiary care institutions and medical college hospitals. To significantly strengthen healthcare delivery, all district hospitals must fully operationalize their Intensive Care Units (ICUs) and 24x7 emergency services within the next seven days. Alongside this, emergency departments in these hospitals must ensure round-the-clock availability of critical diagnostic services, specifically pathology and X-ray investigation. Simultaneously, a comprehensive workforce integration is mandated on the BHAVYA portal. There must be 100% registration of all specialists, General Duty Medical Officers (GDMOs), and paramedical staff posted across all government health institutions, ranging from district hospitals to APHCs. Besides, registered GDMOs who earned specialist qualifications through higher studies or training, and are receiving eligible additional increments, must register as specialist doctors on the portal. To maximize operational transparency and accountability, all government health facilities must upload comprehensive bed availability details onto the portal, covering the entire spectrum from district hospitals to APHCs. Additionally, digital duty rosters for all medical and paramedical personnel must be prepared and uploaded to the platform. This will ensure strict monitoring of timely attendance and guarantee uninterrupted availability of healthcare services for public....