REFERRAL SERVICES
PRESENTED BY:
JAYRAJ SINGH RANAWAT
JCN, BHANDU
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.
REFERRAL SYSTEM
• It is an organizational structure for coordinating,
linking & transferring responsibility of care.
• May be done by:-
1. General to specialist
2. Specialist t specialist
3. One hospital to another
MEANING OF REFERRAL
The practice of sending a patient to another
programme or practitioner for services or advice
which the referring source is not prepared to
provide
DEFINITION
“ The system in which the patient is sent
from the health center with fewer amenities
to the health institution and treatment
center which has more resources, facilities
and amenities is called ‘ referral system”.
REFERRAL PROCESS
• The referral process is systematic problem
solving approach involving series of action that
help clients use resources for the purpose of
resolving needs.
IMORTANCE OF REFERRAL SERVICES
• Providing diagnostic services to patient and
community
• Providing specialty services to the patient
• Providing the purpose of referral system among
health workers
• Teaching the nursing personals for reviewing of
patient sent for referral
• Preventing further complication and for
appropriate teratment
PRINCIPLES OF REFERRAL SYSTEM:-
• The referral should meet the needs and
objectives of the client and should be
necessary and appropriate there should be
merit in referral.
• The client should be able to use the referral
in an efficient, effective manner- it should
be practice.
Cont…
• The referral should be individualized to the
client.
• The referral should me timely.
• The referral should me coordinated with other
activities.
• The referral should incorporate the client and
family member into planning and
implementation.
• The referral should have right to refuse the
referral.
SELECTION OF 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 patients.
Such patient can be divided in three categories
• FIRST GROUP OR FETAL PATIENT
1
• SECOND GROUP OR SERIOUS PATIENT
2
• THIRD GROUP OR GENERAL PATIENT
3
1. FIRST GROUP OR FETAL PATIENT
Such patients can not survive despite the best
treatment made available to them. So, to sent
them for treatment is the waste of time & money
hence it is batter to give them appropriate
treatment at he health centre itself with available
resources.
2. SECOND GROUP OR SERIOUS PATIENT
Condition of such patient is considered serious
but immediate treatment can save their lives. So
before sending them for referral attempt should
be made to reduce the seriousness of condition
and only after that they should be sent for
referral
3. 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 may not threaten his life.
Such patient can be immediately sent for
referral. Similarly after the surgery on incase
diagnosis is not possible.
DIFFERENT LEVEL OF REFERRAL
SERVICES
• PRIMARY LEVEL:- First contact level with a
health centre ( smaller health centers may be called
dispensaries, health station, health post) serving a
defined community or area,. Normally several villages
(at a single village level, at best there might be some
community and auxiliary health workers)
• FIRST REFERRAL LEVEL:- Normally a district
hospital that is recognized referral facility providing a 24
hours intramural medical care which represents a higher
level of competence than the source of referral, eg.
Health centre. It may be very small with few beds
• SECOND REFERRAL LEVEL:- A more
sophisticated hospital. May be a multi specialist intra and
extramural care and serving as a backstop for the first
referral hospital in the hierarchy of technical competence.
• LAST REFERRAL LEVEL:- A most sophisticated
hospital located in a national or provincial capital or other
big city, typically a university level of medical care
available in the country or a region.
TEACHING
HOSPITAL/
SPECIALITY
HOSPITALS
DISTICT
HOSPITAL
COMMUNITY HEALTH
CENTER/ FRUs/
SUBDISTRICT HOSPITAL
PRIMARY HEALTH CENTER
LEVEL
SUB CENER LEVEL
VILLAGE LEVEL
STEPS
• Establish a working relationship with the client.
• Establish the need for a referral.
• Explore resource availability.
• Client decide to use or not use referral.
• Make referral to a resource.
• Facilitate referral.
• Evaluate and follow-up.
BARRIER OF REFERRAL SERVICES
• RESOURCE BARRIER:-
ü Attitude of health care professional
ü Physical accessibility of resources
ü Cost of resources services
• CLIENT BARRIER:-
ü Priorities
ü Motivation
ü Previous experience with resource
ü Lack of knowledge about available resources
ü Lack of understating about need of referral
ü Client self image
ü Cultural factor
ü Finance
ü accessibility
RESPONSIBILITIES OF NURSE IN
REFERRAL
• All nursing personnel working in health center
should have knowledge regarding referral
system. Patient should be carefully selected for
the referral.
• Nurse should be aware of their limitation and
responsibilities in referral system.
• In case of emergency, attempt should be made to
save the life of the patient, and then only he
should be sent for referral.
• Entries in referral form or/ ticket should be clear
and correct, related record should also be
enclosed with it
CONT…
• While sending serious patients, life saving
equipment and medicines should be arrange
with him.
• If facilities are available consultation for the
patient can be procured through telephone,
television network, medical transcription or
internet (telemedicine) etc.
• As far as possible, nurse should accompany the
patient while sending him for referral.
REFERRAL FORM
