REFERRAL SYSTEM

Referral System, involves sending a patient to another physician for ongoing management of specific problem
with the exception that the patient will continue to see the original physician for coordination of total care.

Levels of health care:

 Health care services usually organized at the tree level.
 Primary care level
 Secondary care level
 Tertiary care level

Primary care level:

 This is the first level of contact between the individuals and the national health system.
 This level of care is closest to the people where primary health care is provided
 Organization like sub centers, primary health centers and community health centers.

Secondary care level:

 This care comparies essentially the curative services
 The services are provided at district hospitals, sub – divisional hospitals and community health
centers.

Tertiary care levels:

 This level provides highly specialized health care at the medical college teaching hospitals / state
regional and central level institutions.
 The tertiary level support and complements the action carried out at the primary and secondary level.

OBJECTIVES OF REFERRAL SYSTEM:

 Determine the efficiency and the effectiveness of the services
 Referral should ease the client flow
 Referral should lessen the cost and time spent seeking treatment for the client

CATEGORIES OF CLIENTS NEEDING REFERRAL

Category 1: fatal condition, life cannot be saved even with treatment
Category 2: serious condition ; life can be saved but only with the immediate treatment
Category 3: minor condition , life is not threatened and referral can be delayed

The Following Information Should Be Provide:

 Name of the client/ family
 Address of the client / family
 Present complaints
 Treatment and medication given , if any
 Reason for the referral
 Nursing diagnosis
 Name and designation of the person making the referral
 Name of the sub – centers/ PHC/ CHC making the referral
 Date and time of referral

STEPS OF THE REFERRAL PROCESS:

 Establish a working relationship with the client
 Establish the need for a referral
 Set the objectives for the referral
  Explore resource availability
 Client decides to use or not use referral
 Make referral to resources PHC/ CHC or District Hospitals as relevant
 Facilitates referral - determine if there are any barriers in the use of community services
 Evaluate and follow up

IMPORTANCES OF REFERRAL SYSTEM:

 Providing diagnostic services to patients and community
 Providing specialists services to patients
 Propagating the purposes of referrals system among health workers
 Teaching the nursing personnel’s for reviewing of patients, sent for the referrals
 Preventing further complication and for the appropriate treatment
 Sending the patient comfortably to the referrals institute

URGENT REFERRALS:
 Hyperpyrexia
 Severe pain in the part of the body that is continuous for more than 3 days
 Convulsion or fits
 Hematemesis
 Stiff neck. Jaw with arched back
 Pain in the abdomen
 Frequent vomiting and absence of bowel sound
 Coma, black coloured stool, severe diarrhea or dehydration that is not responding to treatment
 Asthmatic attack and severe cyanosis
 Retention of urine for more than 18 – 24 hours
 Chest pain in heart patient and multiple trauma including fractures & severe hemorrhage
 Complicated accident cases and poisonous conditions
 Any other fatal or life threatening conditions
 Con genital anomalies such as esophageal fistula, imperforate anus and anuria in newborn

ROLES AND RESPONSIBILITIES OF NURSE IN REFERRAL FORM:

 All nursing personnel should have some knowledge about the referral form
 Nurse should be aware of their limitation and responsibilities in the referral systems
 Entries referral form should be clear and correct, relevant record should also be enclosed with it
 While sending the serious patients , life saving equipment’s for example , oxygen and medicines
should be sent with him
 As far as possible , nurse should accompany the patients while him with sending referral
 Some case such as anemic mothers may be referred back to the health workers with appropriate
advise regarding anemia prophylaxis and treatments.
REFERRAL FORM