Community Health Nursing- referral-system

Community Health Nursing- referral-system: topic is from IV year B.Sc Nursing.
It's about the Referral system in health care delivery.

1. REFERRAL SYSTEM IN HEALTH CARE DELIVERY Prepared and presented by Mr.Sarathchandran M.B Nursing Tutor. Swami Vivekananda College Of Nursing . Udgir, Maharashtra.

2. REFERRAL SYSTEM IN HEALTH CARE DELIVERY Subject: Community Health Nursing - 2 Unit: V Topic: Referral System in Health care Delivery Time duration: 60 Minutes Group: B.Sc Nursing IV Year

3. REFERRAL SYSTEM IN HEALTH CARE DELIVERY General objective: Going through the content of this lecture will enable students to understand well about the referral system employed in health care delivery. Specific Objective: After the lecture as per plan students will be able to Define referral system . Types of referral system Purpose and advantages of referral system. Requirements of Effective referral system Selection And referral of cases Nurses responsibility in referral system Reference: BT Basavantahappa ‘s Community Health Nursing Text, 3rd edition

4. Content Introduction and definition Purpose of referral system Advantages of referral system Requirement of effective referral system Selection and referral of cases Referral form model Nurses responsibility in referral system

5. 5 mins Introduction and definitions, Types . 15 mins Purpose and advantages of referral system 15 mins Requirement for referral system 10 mins Selection of cases for referrals. 15 mins Nurses responsibility and conclusion

6. INTRODUCTION At each level of health care infrastructure, there is need for support from higher level of infrastructure and also from secondary & tertiary level hospitals to strengthen and promote credibility of primary health care system. Its against self referral or direct access to hospital. DEFINITION: “Referral system is defined as a system of transferring cases which are beyond the technical competence of one infrastructure to a higher level infrastructure/ institution having technical competency and all other resources to provide desired health 1`services”. NB. Referral does not mean transferring responsibility. But, it’s Sharing responsibility in patient care.

7. Types of Referral : The referral system can be vertical or horizontal in nature., generally in health care delivery system referral means the vertical system. In vertical system the cases can be referred from village health post to SC/PHC, from SC to PHC/CHC and from PHC to CHC/secondary or tertiary level hospital and from CHC to secondary or tertiary level hospital. Provision can be made in vertical system for bypassing 1 or 2 level depending upon the nature and seriousness of cases so that required medical and nursing care can be given on time to the case and mortality and morbidity can be prevented and controlled. In Horizontal system : The cases are referred with the hospital from one specially/faculty to another speciality /faculty for the comprehensive health care.

8. Other Types of Referral : Routine: Seeking expert opinion for diagnosis and prognosis, Hospital admission and management for the case. Seeking further investigations. Emergency: To reach the expert on time before occurrence of deterioration with providing all expected information in referral letter. Opportunistic: For Expert opinion, Admission, Investigations, Management, Mandatory: in which the patient is likely to suffer harm if not referred. Elective: Where the patient is unlikely to suffer harm if not referred. Split-referral: Multi-specialty in the same center. Collateral: As in diabetic patient with glaucoma referral to ophthalmologist KEY POINTS TO EFFECTIVE REFERRAL SYSTEM ARE 3: Mutual understanding of each others role. Mutual respect. Mutual cooperation. Resource availability

9. Levels of V ertical Referral System

10. PURPOSES And ADVANTAGES OF REFERRAL CASES PURPOSES To provide need based comprehensive care within the technical competencies & resources at each level of primary health care infrastructure efficiently and effectively. To help people avail specialized services available at higher level institution which are beyond their reach. To streamline the appropriate use of PHC infrastructure and specialized services in order to prevent overloading of specialized institution by direct uses ADVANTAGES OF REFERRAL CASES Beneficial to patients because they receive effective care at the primary level which is near to their home. Beneficial to health workers because they are able to take care of patients which are within their level of competence and are not frightened to handle difficult cases because they can refer them to higher level centers and referral units. Beneficial to management because it is economical as highly trained and highly paid doctors, nurses and other professionals take care of patients with serious and complex problems at higher level referral unit and patients with simple and minor problems are taken care at much low cost by health workers at lower level. Disadvantages of Self referral / Direct access hospital: Insufficient care. Increase waiting time. Lack of Continuity and follow up. Loosing way between hospital different sectors. Wastage of Resources at all levels.

11. A schematic diagram of referral system.

12. REQUIREMENT FOR EFFECTIVE REFERRAL SYSTEM The referral units of PHC system need to: Well trained required number of professionals, medical equipment & supplies, organization structure etc. Continuing training, guidance & supervision of community health workers. Guidance on sanitary measures & to disseminate information on disease control methods. Conduct health education sessions. Provide logistic supports in terms of equipment & supplies required at PHC. Establish liaison & functional relation with other sectors involved in social and economic development. Organize transportation facilities for cases to be referred. The referral hospital at secondary or tertiary level to: Provide specialized clinical outpatient & inpatient care continuously. Back up primary health care system by providing PH care messages/teaching. Discourage people attending OPD’s directly i.e. to attend OPD when they have referral card/letter or a genuine emergency. Act as teaching center for health professionals including community health workers.

13. SELECTION OF REFERRAL CASES WHEN IT IS REQUIRED The very serious patient requiring immediate medical care & treatment. Patients presenting serious signs & symptoms. He/she may not be experiencing /understanding sickness but requires immediate referral. Minor ailments not resolved with home remedies or by standing orders. When the Health worker/ Nurse / family physician need specific investigation for diagnosis or advice. When the Health worker /Nurse /family physician is dissatisfied with the patient's progress or unsure of the diagnosis/ Atypical manifestations or response to illness or treatment. When the patient or his family shows doubt or lack confidence in the of diagnosis or management. Medical-legal concerns by the physician, the patient or both. For screening during outbreak of diseases / endemic diseases. Disaster triage. For comprehensive healthcare.

14. SELECTION OF REFERRAL CASES THE CASES WHO MAY REQUIRE IMMEDIATE REFERRAL ARE AS UNDER: Cases presenting any problem which cannot be handled during pregnancy, labor and post natal period. Severe diarrhea with dehydration or not responding to treatment. Pain in abdomen and vomiting with or without presence of bowel sounds. Heartburn, dyspepsia, dysphagia, haematemesis and melaena etc. Continuous cough with or without sputum, haemoptysis. Fever with stiff neck. Fever not responding to treatment. Fever with severe joints pain, rashes, bleeding under the skin. Breathing difficulty while walking, sleeping, doing physical work. Chest pain with/without pain in the left arm, restlessness and vomiting. Jaundice, loss of appetite. Convulsions with fever. Coma, paralysis, fracture, severe injury, hemorrhage, poison etc.

15. MODEL REFERRAL FORM : Essential informations. 1. Patient details (name, location, age and sex). 2. Details of family physician(name of physician making request and Name physician being consulted) 3. Reasons for referral. 4. Degree of urgency for appointment . 5. Clinical problem. 6. Important Previous history. 7. Findings on physical examination. 8. Findings on investigation(photocopies of results should be included) . 9. Medication and drug sensitivities. 10. Expected outcome and desirable follow up.

16. MODEL REFERRAL FORM

17. NURSE’S ROLE IN REFERRAL SYSTEM Observe and collect information about the illness, trauma, related situation, factors etc. Identifies the nature of illness/emergency and its seriousness. Provides immediate treatment care within her competence, standing orders and resources available. Assures the casualty/family members/ any other person accompanying. Explains about the seriousness of the problem situation and need for reference to the casualty. Fills up the referral form as desired and hands over the same with related documents to be given to health professionals in referred health center. Arranges for transport of the patient according to feasibility as soon as possible. May do the telephonic consultation or provide information to referred health center. May accompany the casualty/patient if required and feasible. Maintains the records and reports. Provides follow up care as per treatment and instructions prescribed by the referral unit. Establish an office for collecting and sending feedback to the referring physician (two-way referral) at PHC,CHC, MC etc.. Conclusion: it's important to a nurse to understand about referral system to take wise decisions about managing his/her time and delegate responsibilities according to the competency as well as availability of resources while working as a part of a big health care delivery system. So it is just a beginning of a process which would continue by following the patient in the hospital by visits or telephone discussion and on discharge he must be followed through home visits.

18. Home work Ask yourself about each content, what it is? Go through again if cant explain it better and try again until you become familiar with it. Introduction and definition Purpose of referral system Advantages of referral system Requirement of effective referral system Selection and referral of cases Referral form model Nurses responsibility in referral system

19. Thankyou t o the one who made it easy. t o the one from whom i understood it. t o the one who attempt to understand it. to the one taxed for my time and effort. to the one who corrected it further. t o the one who executes this idea. to the one who share it further. to the one who is missed out.