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Template for Workshop 1 (Groupings per ILHZ)

Areas/Elements Existing practices, Policies, Gaps/Deficiencies/Challenges Recommendations for

guidelines and protocols improvement/enhancement
(separate for out-patient and
emergency case if applicable)
Flow of patient’s referral
House BHS RHU referral Referral flow is not followed for
Guide questions: facility(TLJMPH/CLMMRH) RHU for patients nearer to the RHU
1. Make an illustration and or 1st level hospital than the BHS
describe the general
patient/client’s flow from
source to the first level facility
up to the end referral facility
and back.

2. Referral flow for MNCHN

BHS Birthing facility(BHS,RHU)
Referral facility BHS

3. Referral Flow for TB BHS RHU TLJMPH/nearest Tx

satellite for genx/MDR RHU
(MTB not detected, RR not
detected, for evaluation and
treatment) BHS( For DOTS)


4. Referral Flow for Rabies (ABTC)
5. Referral flow for Provincial Hospital with blood request Brgy
Blood Center (indigenous cert, blood donor card)
RHU (blood issuance form)
Blood center Hospital
Communication System

Guide questions:
1. What are the available
communication facilities for Mobile phone/ 2 way radio - Brgy
referral at the following levels:
- purok/barangay Mobile phone/ 2 way radio- BHS
Telephone line
- hospital
(community/municipal) Mobile phone/ Fax/ Email- RHU
District) Telephone line

Mobile phone/ Fax/ Email- Hospital

Telephone line

2. Who is responsible in
when referring patients to the
ff facilities:
BHW/MIDWIFE Midwife not residing in
- BHS to RHU
- RHU to Hospital
MDs/ Nurses catchment area
(community, district)
- Community/district MDs
hospital to Tertiary hospital
Referral form
3. What are the communication Telephone call before transport of Landline not accessible at all Improve communication facilities
and coordination protocols in patient times by installing dedicated hotlines for
referring clients/patients to Return slip referral
the next level or lower level

Transportation System

1. What are the available

transportation facilities at the
following levels:
- purok/barangay Tricycle, habal habal, minicab, brgy Not all brgys have emergency Purchase of ambulance that meets
ambulance . vehicles . DOH standard

Tricycle, habal habal, minicab, brgy Ambulance not functional at all

ambulance . time in the RHU and hospital

- RHU Ambulance

- Hospital Ambulance

2. What are the LGU policies on * Free use of ambulance for Not all LGUs have written policy
the use of residents only.
ambulance/emergency vehicle
*Free use but transport of patients
in referring/transporting
patients? from home to hospital is under the
discretion doctor on duty or nurse
on duty if no doctor.

* Can not transport patient to govt

hospital in Bacolod w/o referral

3. What are the hospital policies Hospital to hospital only and free
on the use of ambulance in for indigents; fuel replacement for
referring/transporting the non indigent.
Disaster vehicle and patrol car. DRRM vehicles are not available
4. When a hospital or LGU at all time
ambulance is not available,
what are the possible options?
No arrangement
5. What is the arrangement
when a private vehicle is being
used in transporting patients?

6. What is the guideline or policy *On duty & on call ambulance Develop policies/ guidelines per
to ensure timely provision of *arrangement with disaster office ILHZ
transportation facilities to to take over when ambulance is not
emergency cases? around.

Accompanying person/staff to
the referred client/patient

1. Who is responsible in
accompanying the
patient/client to the following
- Community to
BHS/RHU/hospital Folks/BHW

- BHS to RHU Folks/BHW/Midwife

- RHU to
community/Municipal/City Case to case basis (Nurse or MD)
- RHU to district hospital
- RHU to tertiary hospital Case to case basis (Nurse or MD)
- District Hospital to tertiary Case to case basis (Nurse or MD)
hospital Case to case basis (Nurse or MD)

2. What will the accompanying Expected to do administer life Lack of training of health
person or health staff saving measure or be able to personnel accompanying the
expected to do when referring handle delivery when necessary. patients
patient to the facility?

3. Who will bear the

Lack of personnel
transportation expense of the N/A
accompanying health staff if Not to be considered as an option
the ambulance is not

Assessing/attending to patients
received at the facility

1. Who is responsible in
receiving the referred
client/patient at the following
- RHU BHW/Midwife
- Municipal/City hospital Midwife/Nurse/Physician
- District hospital Nurse/ Physician
- Tertiary hospital Nurse/ Physician
Nurse/ Physician
2. What are the standard
protocols in Endorsement of referral slip to
assessing/attending to the receiving facility assessment of
referred patients? patients status.
Make necessary plan of

3. How long will it take for the RHU-30mins

patient’s assessment in order Provincial hospital-not more than
to know whether he/she will 30 mins
be admitted or referred to the
next level facility?
Referral slip/form (required

1. What referral slip is being Barangay to BHS -none

used in referring patient from: BHS to RHU- provincial referral form
- Barangay to BHS RHU to Mun/City Hospital -provincial
- BHS to RHU referral form
- RHU to Mun/City Hospital RHU to district hospital- provincial
- RHU to district hospital referral form
- District hospital to tertiary District hospital to tertiary hospital
hospital -provincial referral form

2. What are the guidelines in the RHU: The doctor decides for
filling up of the referral slip? admission and fill up the referral
Who is responsible in filling up
and signing the referral slip? slip. In the absence of the doctor
the nurse decides and fill up the
referral form and signs the referral

3. Who is responsible in
endorsing the referral slip to Health personnel accompanying
the receiving facility? the patient.

4. What is the policy to ensure

that the referral slip is NO EXISTING POLICY. Return referral slip should be 2 way referral slip not practiced
received at the facility? filled up & returned to the
referring health facility
5. When the patient was
admitted at the Provincial referral form.
community/district hospital
and referral to the next level
hospital is needed, what
referral slip will be used?

6. What is the policy to ensure Develop a policy on ensuring that

that the return referral slip will NO EXISTING POLICY. 2 way referral is implemented
be returned and received by
the referring facility?

7. What is the guideline on the No written guidelines but drivers Develop a policy for referring
use of referral slip for patients are instructed to transfer patient to patients picked up at home.
picked up at home or any nearest govt hospital
place by the emergency
vehicle or ambulance?
Recording and reporting of the
referrals Logbook

1. What are the forms utilized
in recording the incoming
Emergency room, admitting
and outgoing referrals?
section, maternity clinic, nurses
2. Where (department,
section, etc) is it being
maintained? Nurses

3. Who is responsible in the

recording of referrals? None

Reporting: For PHO to develop standard

1. What are the forms utilized Nurse forms for monitoring/ reporting of
in reporting of referrals?
2. Who is responsible in filling
up the report forms? RHUs do not submit report of
referral/ Monthly hospital
3. When is the reporting submission to hospital operation
period and where do you division
submit reports?
Monitoring and Evaluation

1. Who is responsible in COH/CHO/MHO/ILHZ

monitoring the SDN and
referral system?

2. What are the areas to

# of referrals made vs # of referral
monitor in order to ensure
proper implementation of slips returned
the SDN and Referral
System in the Province of
Negros Occidental?

3. How often will the

monitoring be done?
4. What are the possible Results pf monitoring to be
venues or meetings where TWG ILHZ meeting discussed during the ILHZ board
the results of the meeting.
monitoring can be properly
discussed and acted upon?
Policy Support Develop local legislation to be
discussed during ILHZ meeting.
1. What policies should be in Local issuances (E.O, resolutions)
place to ensure proper
implementation of the SDN
and referral system in the
Province of Negros
Policy for Medico-Legal Cases

1. Who will act as Medico Legal MHO/CHO

Officer in the Municipality?

2. What are the All medico legal cases are handled

protocols/guidelines in
by the MHO/CHO where the
handling medico-legal cases?
incident occurred or or by the
hospital where the patient is
managed , unless arrangement is
made between the ILHZ member
where the MHO/CHO not available