Intervention
A virtual triaging system for the identification and evacuation of those
who needed hospitalization and to facilitate home management for mild
and asymptomatic patients was proposed. This article presents an
integrated patient management system established via short
message services (SMSs) and telephone helplines, with the involvement of
multiple stakeholders. Four key stakeholders, the National Operation
Centre for Prevention of COVID-19 Outbreak (NOCPCO), Sri Lanka Medical
Association (SLMA), the Ministry of Health and National Ambulance
Service were brought together with the cooperation and support of
national telecommunication service providers.
The approach was to integrate and expand on existing services. The 247
Doc Call Service under the SLMA was already in operation to provide
advice for COVID-19 patients since 2020. The ambulance service,
“Suwaseriya”, was operating under the toll-free telephone code of
1990. In addition to the above services, a SMS gateway with the
toll-free telephone code 1904 was established in NOCPCO.
The integrated system was established to coordinate the abovementioned
separate operations to achieve the following objectives:
(a) Reduce the number of non-urgent admissions to the hospitals,
(b) Provide correct information to patients
(c) Identify and evacuate patients who need urgent care to hospitals.
As the number implies 247 is a twenty-four hour seven days of the week
service, made available in all three national languages, Sinhala, Tamil
and English used in Sri Lanka. All medical professionals rendered their
services on a volunteer basis.
The 1904 SMS service was for COVID patients to contact the National
Operations Centre for help. The SMS service was available even in a
basic mobile phone and could be operated by a patient without much
skill. The general public was informed through media to submit their
basic details via an SMS. The symptom profiles were categorized as A, B
and C for urgent action (Shortness of breath was designated as A, other
symptoms by B and asymptomatic test positivity by C). The patients start
the message typing the letters A, B or C based on their perceived
symptoms. Information based on SMS is immediately directed to a medical
team stationed at the operations room of the NOCPCO, where the patient
is evaluated over the phone and decisions were made on the necessity for
urgent evacuation to a hospital. The details of those who need urgent
medical care were notified to the ambulance system and a focal point in
the Ministry of Health for allocation of a hospital bed for urgent
evacuation.
Category B were triaged and those who required medical attention were
transferred to an appropriate facility through a health-military
coordinated evacuation mechanism. Category C patients were given
necessary medical advice to remain at home with the provision of
information for self-care. Pulse oximeters for self-monitoring at home
were distributed free of charge to the needy patients. This integrated
system is summarized in Figure 1.