Community Health Nursing

Sacred Heart College

Bachelor of Science in Nursing

Referral System
Primary, Secondary, and Tertiary
 Referral System
1 A system of transferring cases which
are beyond the technical competence
of one infrastructure to higher level
infrastructure/institution having
technical competency and all other
resources to provide desired health
services".
Referral System
2 A process in which a health worker at
one level of the health system, having
insufficient resources (drugs, skills,
equipment) to manage a clinical
condition, seeks the assistance of a
better or differently resourced facility at
the same or higher level to assist in, or
take over the management of the
client's case.
 Referral System
Department of Health

3 Health Referral is a set of activities

undertaken by a health care provider or
facility in response to its inability to
provide the necessary intervention of
patient’s need.

4 It involves not only direct patient care

but support services such as
transportation to transfer patient from
one health facility to another.
 Department of Health

Health referral is a two-way relationship

that requires cooperation, coordination,
and exchange between the primary
health facility and the first referral
hospital during the referral and
discharge of the patient from the
hospital
Purpose of
To seek an expert opinion regarding the client.
To seek additional or different services for the

Referral
client.
To seek admission and management of the

System
client.
To seek use of diagnostic and therapeutic
tools.

To avoid duplication of services

Promotes cooperation and complementation

of primary, secondary and tertiary health
facilities

Promotes continuity of treatment

Major effects of deficiencies in
the health referral system:

1. Decreased Efficiency

2. Decreased Effectiveness

Decreased Efficiency
There is a wastage of scarce
health resources through
duplication of services and
under utilization of primary and
secondary government hospital
Major effects of
deficiencies in the
health referral
system:
1. Decreased Efficiency
2. Decreased Effectiveness
 Major effects of
Decreased Effectiveness deficiencies in the
health referral
There is an increase in
preventable morbidity and
system:
mortality due to a lack of
appropriate services, delayed
1. Decreased Efficiency
referral, and poor referral 2. Decreased Effectiveness
communications.
When does a patient be
referred to a higher
level of care?

requires a technical intervention

that is beyond the capabilities of
the health center
requires an in-patient care
Level of Health Care System
Primary, Secondary, and Tertiary Level of Care
Primary Level of Care
Devolved to cities and municipalities
Usually the first contact between the
community members and other levels of the
health facility.
Center physicians, public health nurses,
rural health midwives, traditional healers.
 Secondary Level of Care
Given by physicians with basic health
training.
Usually given in health facilities either
privately owned or government-operated.
Infirmaries, municipal, district hospital, out-
patient departments.
Rendered by specialists in health facilities.
Tertiary Level of Care
Referral system for the secondary care
facilities.
Provided complicated cases and intensive
care.
Medical centers, regional and provincial
hospitals, and specialized hospitals.
Types of Services available in each referral levels:

Primary Level of Care

Barangay Health Stations

Sanitation
Immunization
Contact Tracing

Rural Health Unit

Out-patient Services
Normal Delivery
(pre and post-natal)
Minor Surgeries
Types of Services available in each referral levels:

Secondary Level of Care

District Hospitals
Surgical
Radiological
Laboratory Services
Types of Services available in each referral levels:

Tertiary Level of Care

Provincial Hospitals
Dialysis Services
Cardiac Monitoring
Transplant Services
 Department of Health

AN ACT PROHIBITING THE DEMAND OF DEPOSITS OR

ADVANCE PAYMENTS FOR THE CONFINEMENT OR
TREATMENT OF PATIENTS IN HOSPITALS AND MEDICAL
CLINICS IN CERTAIN CASES.
Batas Pambansa Bilang 702
 Department of Health

AN ACT PENALIZINGTHE REFUSAL OF

HOSPITALS AND MEDICAL CLINICS TO
ADMINISTER APPROPRIATE INITIAL
MEDICAL TREATMENT AND SUPPORT IN
EMERGENCY OR SERIOUS CASES,
Republic Act 8344
Thank you!
"Caring is the essence of Nursing"
- Jean Watson