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.