Referral System in India

“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 services.”

1. Presented by: Harsh Rastogi , Nursing Tutor, M.S. Institute of Nursing, Lucknow . Referral system in India

2. 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.

3. 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 services.”

4. Cont… The referral system is vertical in nature. 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.

5. Provision is made 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.

6. Purpose 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. T o streamline the appropriate use of PHC infrastructure and specialized services in order to prevent overloading of specialized institution by direct uses.

7. Requirement of effective referral system The referral units of primary health care 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.

8. Cont… 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.

9. Cont… R eferral hospital at secondary & tertiary level need to: Provide specialized clinical outpatient & inpatient care continuously. Back up primary health care system by providing primary health 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 centre for health professionals including community health workers.

10. Selection of referral cases The very serious patient requiring immediate medical care & treatment. Patients presenting serious signs & symptoms. He/she may not be sick but requires immediate referral. When special diagnostic procedures are required for diagnosis.

11. Cases requiring immediate care The cases who may require immediate referral are as under: Cases presenting any problem which cannot be handled during pregnancy, labour and post natal period. Severe diarrhoea with dehydration or not responding to treatment. Pain in abdomen and vomiting with or without presence of bowel sounds.

12. Cont… Heart burn, dyspepsia, dysphagia , haemetemesis and maleana 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.

13. Cont… 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, haemorrhage, poison etc.

14. 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 centres and referral units.

15. Cont… 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. Patients with simple and minor problems are taken care at much low cost by health workers at lower level.

16. Key points to effective referral system

17. Role of Community Health Nurse 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.

18. Cont… 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 centre. Arranges for transport of the patient according to feasibility as soon as possible. May do the telephonic consultation or provide information to referred health centre.

19. Cont… 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.

20. Gracias !