Referral System.pptx

Referral system in health service delivery in India .Community health

1. Referral System

2. Definition “ Referral System refers to t he system in which the patient is sent from the H ealth Centre with fewer amenities to the Health Institution or Treatment Centre , which has more resources , facilities and amenities .”

3. Concept of an Ideal Referral System a . Referrals is a process of directing a client to another source of service / assistance / information . b . Referrals is one of the key function of a Community Health Nurse c. Referral system is an organizational structure for coordinating, linking & transferring responsibilities of care from one level to another. Eg . Primary level to Secondary level Generalist to a specialist A specialist to another specialist A hospital to another hospital

4. 1. To provide need based comprehensive care within the technical competencies & resources at each level of primary health care infrastructure efficiently and effectively. 2. To help people avail specialized services available at higher level institution which are beyond their reach. 3 . To streamline the appropriate use of PHC infrastructure and specialized services in order to prevent overloading of specialized institution by direct uses. PURPOSES…

5. A . Traditional R S C . Others B. Modern R S Referral System Types / Classification.

6. A . Traditional Classification a. External b. Internal i . Vertical ii. Horizontal Patient referral from lower to higher level facility Patient referral from one facility to other facility and Vice versa. Patient referral usually within the health facility , from one health personnel to another.

7. c. Cross Referral a. Interval Referral b. Collateral Referral d . Split Referral Types / Classification of RS B. Modern Classification e. S elf - Referral

8. a. Interval Referral The patient is referred for complete care for a limited period. b . Collateral Referral The referring MD retains the overall responsibility , but refers patient for care of some specific problems. E.g Cardiac problem

9. E. S elf - Referral d . Split Referral The responsibility is divided between 2 or more MDs . c . Cross Referral The patient is referred to another MD , once accepted, the referring MD has no more responsibility in patients care . Patient himself make referrals.

10. C. Other Types Intra disciplinary Referral System b . Inter- disciplinary Referral System . When a patient cannot be treated, neither properly diagnosed, nor satisfied with a particular treatment or therapy, then he can be referred to another therapy of same discipline for needful. Intra disciplinary Referral System

11. Other Types cont … b . Inter- disciplinary Referral System . The patient shifts often from one system / discipline to another discipline. Eg . Allopathic to AYUSH treatment .

12. V. Importance of RS 1. Providing diagnosis service to patients and community 2. Providing specialists services to the patients . 3. Propagating the purposes of referral system among the health workers . 4 . Teaching the nursing personnel for reviewing of patients & sent for referral. 5. Preventing further complications and providing appropriate treatment 6. Safe Referral Transport - Sending the patients comfortably to the referral institute .

13. VI. Principles of an Ideal Referral System It should be … Merit in Referral process - Based on Need and Objectives b. Practical - No waste in Time & money c. Individualized Care - Meet the need of patients

14. VII. Selection of Patients for Referrals A. First Group/ Final Pts. B. Second group / Serious Pts. C. Third Group / General Pts.

15. Selection of the Patient…. Such patients cannot survive despite the best treatment made available to them. Sending them for treatment is the waste of time & money. A . First group or Final patients. It is better to give them appropriate treatment at the Centre itself. Make the relatives of the patient to understand that, it will not be beneficial to send the patient for referral.

16. B . Second group or Serious Patients Conditions of such patients are considered serious but immediate treatment can save their lives. So before sending those for referral, attempt should be made to reduce the seriousness of condition and only after that should they sent for referral. Selection of the Patient….

17. C . Third Group or General Patients Though the disease may be serious in such patients still the condition of the patient is found to be normal. Selection of the Patient…. E.g. after surgery or in case of diagnosis is not possible or for use of some special technique , patient can be sent to a big / special hospital for consultation.

18. VIII. Levels of Referral System A. Primary Level B . Secondary Level C . Tertiary Level In our health system , referral services are provided at three levels..

19. Secondary Level Primary level S C Flow Chart - Referral services P H C District HQ Hospital C H C At Village Level ANM, ASHA, TBA, AWW, VHG Taluka HQ Hospital At Taluka Level District Level (Community Health Worker, Village Health Post) (Govt. HCs ) (Govt. Hospitals / Pvt. Hospitals) Tertiary level State Level Specialty Hospitals Medical College Hospitals Regional Hospitals ( Super Specialty Hospitals ) Sub Divisional Hospital (Govt. Hospitals)

20. 1. When the family physician need specified investigation / advice 4. Medical - legal concerns by the physician, Patient or both . 3. When the pt./family shows doubts / lack of confidence in the present diagnosis and Treatment . 2 . When the family physician dissatisfied with patient’s progress IX. When to Refer ?

21. 8 . Evaluate & follow up. 5. Get Patient’s choice - to use or not 4. Explore the resources availability 7. Facilitate and coordinate RS 3. Set Objectives for the referral 2. Establish the need for a referral 1. Establish a good relationship with the patient. 6 . Make pre-referral treatment Steps of Referral Process

22. XI. a . Referral Form Name of the Health Centre/ Hospital Name of Referral Unit…………………………………………………….. Referral Registration Number………………………………………... Name of the patient………………………………………………………. Father/Husband’s Name………………………………………………… Age…………………….Sex………………….Religion…………………….. Occupation………………………………………… Present Diagnosis……………………………. Case History in short……………………………………………………….. Description of treatment given……………………………………….. Date of sending Referral………………………………………………….. Cause of sending for Referral …………………………………………… Signature Enclosed papers Nam of the sender……………………………. Designation………………………………………

23. Additional findings 2. Diagnostic work up done with the results . 3. Final Diagnosis 4. Plan of Management b. Reply Form

24. Benefits of Referrals a. For patient b . For family physician c . For consultant . a. For patient Prompt diagnosis and Management Save money, time and effort Better services and outcome.

25. Benefits of Referrals cont … b. For family physician c. For consultant / Agency. Learning and training Gaining self confidence in treatment Increase communication b/w health care staffs Improve the quality of the patient’s management 2. Increase communication b/w health care system

26. Problems a nd Suggestions

27. Problems Poor knowledge on referral system & services Lack of co-ordination between different levels Structural & clinical constraints at different levels No use of patient referral form & reply form No patient involvement in referral services 6 . Improper recording & reporting of referrals 7 . Delayed referrals & time lag for getting efficient care. 8 . Lack of adequate resources 9 . Inappropriate identification of referral resources 10. High cost of care 11. Ineffective utilization of existing resources

28. b. Suggestions . Strengthening Referral S ystem Systematically built referral system Strict criteria for referral services ( - specific information & - Agency , - P rotect patient’s right, - Patient Referral form, - Reply form etc)

29. 4. Update the knowledge of health professionals 5. Structural & clinical strengthening at different levels. 6. Ensuring quality of services at different levels. 7. Develop a common patient referral forms & reply forms . 8. Well coordinated referral services 9. Proper recording & reporting of referrals 10. Better house keeping at hospitals 11. Involve patients in referral services 12. Avoid delayed referrals & patient waiting time 13. Identify appropriate referral system Suggestions …

30. 14. Ensure adequacy of resources 15. Effective & proper utilization of existing resources 16. Proper evaluation of referral services 17. Improve efficiency of services 18. Be a referral resource personal & provide consultation. Suggestions …

31. Responsibility of the C H Nurse in Referral System.

32. Responsibility of the Nurse in Referral System Updated knowledge of Referral System. Careful selection of patients Awareness of limitations and responsibilities In emergency, save the life of patient, then sent for referral . All entries - clear and correct & Enclose necessary records 7 . Arrange life saving equipment, medicines etc 8 . Accompany if necessary

33. Thank You…