a process in which the P.H.C physician who has lesser facilities to manage clinical condition seeks the assistance of specialist partner with resources to guide in managing clinical episode.

1. Mohamed Abdelmongy & hatem El-Sheemy
Misr University for Science and Technology
MBBCh Candidate

2. 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.
Definition

3. Also defined as…
a process in which the P.H.C physician who has lesser
facilities to manage clinical condition seeks the
assistance of specialist partner with resources to
guide in managing clinical episode.

4. NB. Referral does not mean transferring
responsibility. But, it’s Sharing
responsibility in patient care.

6. When to refer ?
• When the family physician need specified investigation or advice.
• When the family physician is dissatisfied with the patient's progress
or unsure of the diagnosis.
• When the patient or his family shows doubt or lack confidence in the
of diagnosis or management.
• Medical-legal concerns by the physician, the patient or both .

7. Factors affecting referrals ?
a. Availability of qualified consultants.
b. Physician specialty.
c. Length of training.
d. Unexplained findings.
e. Uncertainty of diagnosis
f. Patient characteristics.
g. Reimbursement plan
Factors Affecting Referrals..

8. 1. The decision is made.
2. Consideration is given to the patient's
medical, emotional, cultural and
socioeconomic background.
3. Selection of appropriate specialty and
appropriate physician in the field.
4. Preparation for both the patient and
the family for consultation.
5. Preparation of the consultant.
Referral Process
6. The consultant provides feedback to the
family physician.
7. The family physician evaluates the
appropriateness of the consultant's
recommendation.
8.The family physician facilitates the patient
and the family's acceptance of recommendation.
9. The family physician acts on the recommendations
or selects another consultant in the same or
different field.
10. The family physician provides feedback to the
consultant regarding the outcome

10. STEPS OF THE REFERRAL PROCESS:
1. Establish a good relationship with the patient.
2. Establish the need for a referral.
3. Set objectives for the referral.
4. Explore resources availability.
5. Patient decides to use or not use.
6. Make pre-referral treatment.
7. Facilitate, coordinate referral.
8. Evaluate and follow up.
Steps of Referral Process

11. Benefits of referral:
For the patient
- Prompt diagnosis and management
- Save time, money and effort.
- Better outcome
For the family physician
- learning and training
- Gaining self confidence.
- Increase communication between the health care staff
For the Consultant
- Improve the quality of the patient's management.
- Increase communication between the health care staff
Benefits of Referral

12. 1. Patient details (name, location, age and sex).
2. Details of family physician(name of physician making request and Name
physician being consulted)
3. Reasons for referral.
4. Degree of urgency for appointment .
5. Clinical problem.
6. Important Previous history.
7. Findings on physical examination.
8. Findings on investigation(photocopies of results should be included) .
9. Medication and drug sensitivities.
10. Expected outcome and desirable fpllow up.
Referral letter outline

13. Types of Referral
According to
the case
Modern
Classification

14. Routine
Seeking expert opinion for
diagnosis and prognosis
Seeking Hospital admission and
management for the case.
Seeking further investigations
Emergency
To reach the expert on time before
occurrence of deterioration with providing
all expected information in referral letter.
Types of Referral
Opportunistic
- For Expert opinion - Admission
- Investigations - Management

15. Mandatory
• in which the patient is likely to suffer harm if not referred
Elective
• Where the patient is unlikely to suffer harm if not referred.
It can be classified according to the case to:

16. Modern Classification
Interval
Patient with MI admitted in hospital for a
period of then return for continuity of time
Collateral
As in diabetic patient with glaucoma referral
to ophthalmologist
Cross-referal
Self - Referral
Split-referral
Multi-specialty in the same center.

17. 4Levels of Referral
1st
• From family physician primary health care to hospital specialist.
2nd
• From specialist to another specialist.
3rd
• From junior specialist to senior specialist.
4th
• from general hospital to specialized hospital

18. Disadvantages of
Self Referral and Direct access to hospital
Insufficient
care
Increase
waiting
time
Lack of
Continuity
and follow-
up
Loosing
way
between
hospital
different
sectors
Wastage of
resources
at all levels

19. Basic Principle of Referral
Merit in the
referral process
(need-objective).
Practical
Not waste in time and
or money)
Individualized to
client
Referral that met the need
of one patient not large
number of patient
It should be..

20. So, it’s not an end, but just a beginning!
• is just a beginning of a process which would continue by following the
patient in the hospital by visits or telephone discussion and on discharge
he must be followed through home visits.
• The hospitals should establish an office for collecting and sending feed
back to the referring physician (two-way referral)
Referral System