REFERRAL
SYSTEM
PRESENTED BY
SHEETAL SHARMA
INTRODUCTION
At each level of health care infrastructure, there is need for support
from higher level of infrastructure and also from secondary and
tertiary level hospitals to strengthen and promote credibility of
primary health care system.
CONT…
Referral system is an essential component of health care system. From
rural level to metropolises and from health sub-centres to specialist
hospitals, all kinds of health facilities can be provided to the
community through this system
REFERRAL SYSTEM
It is an organizational structure for coordinating, linking, &
transferring responsibility of care.
This may be done by:
A generalist to a specialist.
A specialist to a specialist.
One hospital to another.
MEANING OF REFERRAL
The practice of sending a patient to another program or
practitioner for services or advice which the referring
source is not prepared to provide
DEFINITION
The system in which the patient is send from the health centre having
fewer amenities to the health institution or treatment centre, which has
no more resources, facilities and amenities, is called referral system.
CONT…
REFERRAL DOES NOT MEAN TRANSFERRING
RESPONSIBILITY.
BUT,
IT’S SHARING RESPONSIBILITY IN PATIENT
CARE.
WHEN TO REFER
When the family physician need specified investigation or advice?
When the family physician is dissatisfies with the patient’s
progress or unsure of the diagnosis?
Medical legal concerns by the physician, the patient or both.
PURPOSES OF REFERRAL
SYSTEM
To reduce the mortality and morbidity rate.
To improve basic environmental sanitation.
To increase the life expectancy of the individual.
To improve the nutritional status.
To develop man power and other resources.
REFERRAL PROCESS
The referral process is a systematic problem solving
approach involving series of action that helps clients use
resources for the purpose of resolving needs.
IMPORTANCE OF
REFERRAL SYSTEM
Providing diagnostic services to patient and community.
Providing specialty services to the patient.
Providing the purposes of referral system among health workers.
Preventing further complication and for appropriate treatment.
PRINCIPLES OF
REFERRAL SERVICES
It should meet the needs and objectives of the client and should be
necessary and appropriate. There should be merit in referral.
The client should use of referral services in effectively and efficient
manner.
It should be practice.
It should be individualized to the client.
CONT…….
It should be timely.
It should be coordinated with other agencies.
The referral should incorporate the client and family into
planning and implementation.
To referral services should have the right to refuse the referral.
SELECTION OF THE
PATIENT FOR REFERRAL
Which patient should be sent for referral or what should be the basis
of patient by referral system. This depends upon the resources
available in the health centre and the condition of the patient such
patients can be divided into three categories.
FIRST GROUP OR FATAL PATIENT
SECOND GROUP OR SERIOUS PATIENT
THIRD GROUP OR GENERAL PATIENT
FIRST GROUP OR FATAL
PATIENT
Such patients can not survive despite the best treatment made available
to them. So, to send them for treatment is the waste of time and money
hence it is better o give them appropriate treatment at the health centre
itself with available resources.
SECOND GROUP OR
SERIOUS PATIENT
Condition of such patients is considered serious but immediate
treatment can save their lives, so before sending them for referral,
attempts should be made to reduce the seriousness of condition and only
after that they should be sent for referral.
THIRD GROUP OR
GENERAL PATIENT
Though the disease may be serious in such patients still the condition of
the patient is found to be normal delayed treatment may not threaten his
life such patients can be immediately sent for referral. Similarly after the
surgery or in case diagnosis is not possible.
DISTRICT HOSPITAL
COMMUNITY HEALTH CENTER
PRIMARY HEALTH CENTER
SUB-CENTER LEVEL
VILLAGE HEALTH WORKERS
DIFFERENT LEVEL OF
REFERRAL SERVICES
PRIMARY LEVEL
It is first contact level with a health centre (small health canters may be
called dispensaries, health stations, health posts) serving a defined
community or area- normally several villages (at a single village level,
at best there might be some community or auxiliary health workers).
CONT…
FIRST REFERRAL LEVEL
Normally a district hospital that is recognized referral facility
providing a 24- hour intramural medical care which represents a higher
level of competence than the source of referral e.g. health centre. It
may be very small with just few beds.
CONT…
SECONDARY REFERRAL LEVEL –
A more sophisticated hospital (may be a provincial hospital) providing
multi-specialist, intra and extramural care, and serving as a backstop for
the first referral hospitals in the hierarchy of technical competence.
CONT…
LAST REFERRAL LEVEL
A most sophisticated hospital located in a national or provincial capital
or other big city, typically a University teaching hospital providing the
highest level of medical care available in the country or region.
STEPS IN REFERRAL
1. Selection of patient and establish the need for referral.
2. Set objectives for referral.
3. Inform the patient/relatives.
4. Identify the resources available.
5. Provide alternative available resources.
6. Take consent from patient/relatives.
CONT…
7. Provide necessary pre-referral treatment/care.
8. Prepare referral form.
9. Facilitate transportation.
10. Follow- up.
BENEFITS OF REFERRAL
FOR THE PATIENT
Prompt diagnosis and management.
Save time, money and effort.
Better outcome.
CONT…
For the physician
Learning and training.
Gaining self confidence.
Increase communication between the healthcare staff.
BARRIERS OF REFERRAL
PROCESS
RESOURCE BARRIERS
Attitudes of health care professionals.
Physical accessibility of resource.
Cost of resource services.
CONT..
CLIENT BARRIERS
Priorities and motivation.
Previous experience with resources.
Lack of knowledge about available resources.
Client self image.
Accessibility.
ROLES AND
RESPONSIBILITIES OF CHN
Observe and collect the information.
Nurses should be aware of their limitations and responsibilities in
referral system.
In case of emergency, they should attempt to save the life of the patient
before referral.
Entries in the referral form should be clear and correct.
CONT..
While sending serious patients, life-saving equipment/medicines
should be arranged.
Nurses should explore and use the available resources for
transportation.
Nurse should accompany the patient while sending him for referral.
SUMMARY
CONCLUSION
