At the end of the class students
are able to
Define referral system.
Reason for referral.
Rationale for referral.
Characteristics of referral system.
Levels of referral system.
List the types of referral system
Components, perspectives and issues ,
A referral system is a mechanism that
enables a patient’s health needs to be
comprehensively managed using
resources beyond those available at the
location they access care from, be it in a
community unit, dispensary, health centre
or a higher level facility
REASONS FOR REFERRAL
To seek expert opinion.
To seek additional or different services.
To seek admission and management
To seek use of diagnostic& therapeutic
For continuity of care
Patient should be given optimal care at
the right level, right time and right cost.
Optimal and cost efficient utilization of
health care system.
Optimal and appropriate utilization of
specialist services for needy persons
Optimal utilization of primary health care
RATONALE OF REFERRAL
Most common, most complicated and
life threatening diseases requires
Maximize limited resources & avoid
duplication of services.
Ensures a close relationship between
all levels of the health system.
Helps people receive the best possible
care closes to home
Support primary health centers.
Helps to build capacity.
Reduce the high proportion of
customers seen at the outpatient
clinics at 2nd facilities.
LEVELS OF REFERRAL SYSTEM
Primary level of care:(PHC)
Developed to urban and rural areas
Referral site for the village health worker
& basic health units
Usually is the 1st contact level between
community & other levels of health
Provide management for common &
minor alignment requiring simple
Secondary level of care:(District Hospital)
Referral site for the primary care facilities
Given by physicians with basic health training.
Usually given in health facilities either private
owned or government operated
Rural hospitals, state general hospital, out-
patient department are main sites of care.
Rendered by specialists in health facilities.
Tertiary level of care: (Superspecality Hospitals)
Referral site for the secondary care facilities.
Can be medical centers, regional, provincial
hospitals and specialized hospitals.
Provide care for complicated, uncommon and
serious diseases requiring highly specialized or
high technology interventions.
REFERRAL SYSTEM IN INDIA
Primary Health Centres(PHC)
Community Health Centres(CHC)
Sub District Hospitals
Tertiary Level Facilities In Medical
Super Speciality Hospitals In India
Can be adjusted relevant to the local
Components can include:
Referral process at the 1st level of care
Referral process at 2nd or tertiary level
Supervision and capacity building
PERSPECTIVES & ISSUES OF
HEALTH SYSTEM ISSUES
Service providers & quality of care.
Performance expectations &
involvement of organization.
All service providers are expected.
Follow the agreed protocols of care.
REFERRAL PROCESS AT 1ST LEVEL:
During visits of H.C, it is important that the
For proper performance the health workers
Protocols need to include
Making decision to refer comes after the
gathering and analyzing relevant information
using protocols as a guide
Deciding to refer dose not mean that the health
workers is inadequate or bad.
adoption of standardized referral forms to
ensure equality whenever a referral is
patients referred out should be
Carefully filled referral card cab helps to get
timely attention at the receiving facility.
REFERRAL PROCESS AT 2ND OR 3RD
The receiving facility
SUPERVISION AND CAPACITY BUILDING:
Facility managers & supervisors at all
levels should monitor all referrals to &
Supervisors should discuss referred
Kamalam. S, “ESSENTIALS IN
COMMUNITY HEALTH NURSING
PRACTICE”, 1st edition, 2008 jaypee
brothers, new Delhi, page no, 105-110
B. T. Basavanthappa “COMMUNITY
HEALTH NURSING”, 1st edition, 2008
jaypee brothers, Mumbai, page no 30-
Kasturi sundar rao, “community health
nursing”, BI publications;265-270