Social media and messaging services like WhatsApp have found an important place in the medical field and patient care. It has been widely used for intra-institutional referral, patient awareness and medical education [1], and also for telemedicine [1,2]. However, its use in inter-institutional referrals and patient transfer is not widely documented.

Lack of a proper referral system affects patient care as many are referred to tertiary centers due to non-availability of specialized services in local hospitals. In majority of the cases the referrals are not planned, and it is not through institutional mechanisms. Hence, the patients visit the hospital on their own, and may face refusal. This causes significant delay in treatment which contributes directly to morbidity and mortality. We used WhatsApp as a medium to facilitate transfer of pediatric patients, including neonates, from pediatric department of one hospital (which does not have pediatric surgical support) to our tertiary care hospital. The WhatsApp group included the consultants and residents of the concerned department from both the hospitals. Patient details, investigations (biochemistry, hematological and radiological) are initially uploaded on the group. We assess the case on the messenger and coordinate the transfer. The patient is then transferred to us in an ambulance with an accompanying doctor. Our team saves a lot of precious time in investigating these patients as they have already been done as per our requests, and surgery is planned at the earliest based on the indication and patient condition. The total number of cases transferred since the creation of this group (June, 2019) was 182 (140 newborns and 42 older children). Surgical findings and the post-operative course of the patient is also shared with the other team, which results in their learning process. Many patients follow-up at the referring hospitals after the surgical problems have been taken care of.

There are; however, certain minor drawbacks of this system. During the initial days, some children with surgical problem were referred to our hospital and when we took consent for surgery, the parents refused. We improvised by ensuring that the referring hospital took consent for transfer and possible surgical intervention before updating patient details on Whatsapp. Another aspect which needs attention is that sensitive patient data is being shared and retained on this platform. We have devised a two-pronged solution to this problem. Firstly, keeping record of all patients physically (either analog or digital) at the referred hospital and periodically delete all archived data. Lastly, taking consent from parents, regarding sharing of their patient’s details by this method for the purpose of transfer. We prefer the latter as the archived data can be used for retrieving patient details later, as was done in this study. The archived data is also a very vital tool to follow-up patients, by either of the two institutions. We suggest use of newer communication methods for ensuring adequate referral and management of patients, particularly in countries which lack an organized infrastructure to support such services.

1. Giansanti D. WhatsApp in mHealth: An overview on the potentialities and the opportunities in medical imaging. Mhealth. 2020;6:19.

2. Telemedicine Practice Guidelines. 2020. Accessed June 10, 2020? Available from: https://www.mciindia.org/CMS/wp-content/uploads/2019/10/Public_Notice_for_TMG_ Website_ Notice-merged. pdf

3. Othman M, Menon V. Developing a nationwide spine care referral programme on the Whatsapp messenger platform: The Oman experiment. Int J Med Inform. 2019;126:82-5.

4. Joshi SS, Murali-Krishnan S, Patankar P, Choudhari KA. Neurosurgical referral service using smartphone client WhatsApp: Preliminary study at a tertiary referral neurosurgical unit. Br J Neurosurg. 2018;32:553-7.

5. Morkel RW, Mann TN, Preez GD, Toit JD. Orthopaedic referrals using a smartphone app: Uptake, response times and outcome. S Afr Med J. 2019;109:859-64.