POLICY ON PATIENT REFERRAL

SERVICES
PHC PALANA

CONTRIBUTED BY: DISTRICT QUALITY ASSURANCE UNIT,

KHEDA

This Policy is issued under the authority of MO – Dr. Ravit I Patel,

PHC – Palana , Vaso , Dist. Kheda,

Gujarat, India, Pin. 387350.

Document No. PHC PALANA/Guj/006/ Policy on Patient

Referral Services.
 ISSUE NO. : 01.
 COPY NO. : 01.
 VERSION NO. : 2019.
 ADDRESS : PHC PALANA,VASO ,KHEDA, GUJARAT 387350
 DIST. : KHEDA.
 STATE : GUJARAT
 PIN. : 387350.
 EMAIL ID :PHCPALANA@YAHOO.COM
Prepared by :-

Dr. Ravit I Patel

1|Page
 PRIMARY HEALTH CENTER – PALANA
TALUKA – VASO , DISTRICT- KHEDA – GUJRAT, 387350

Doc No. PHC-Palana/Guj/006/ Referral Policy

NQAS Standard Reference E3.2

Issue/ Revision No.

1/00
Date of issue /Effective Date: 01-04-2019

Page No. Page 2 of 9

DISTRICT QUALITY ASSURANCE UNIT, KHEDA

Referral Policy in IPD & Emergency

Name of Service

Referral Policy
Name of Manual
PHC PALANA /IPD/006/19
Manual No.
To ensure that procedures to guide referral of patient
Purpose
from emergency , IPD Department
Responsibility All members of Medical , nursing ,Administration
Name and Designation Signature Date
Chairperson, Quality Assurance
Prepared& Committee,
01/04/2019
Issued By : Primary Health Center – Palana
Dr.Ravit I Patel
District Quality Assurance Medical
Reviewed
Officer, 01/04/2019
By :
DR P R TRIVEDI
Chief District Health Officer
Approved
(C.D.H.O) 01/04/2019
By :
Dr. D C Jagani.

1.0 POLICY

2|Page
 These include those patients who have been admitted for the treatments in the hospital.
Patients who do not match the scope of services of hospital are referred and/or transferred
to the hospital with requisite facilities. If there is a choice for external facility patient’s /
relatives preference are considered.

a) Patient brought to the emergency in life threatening situation and needs to be

transferred.
b) Patients already admitted in hospital seeking transfer to another hospital for whatever
reason, needs to be transferred.

2.0 PURPOSE
To safely transfer the patient outside the facility.

DEFINITION:-

1) Unstable patients - Any patients whose vital signs (heart rate, blood pressure,
respiratory rate, oxygen saturation, level of consciousness) are compromised.
Eg. in cases of Polytrauma, shock, Status epileptics, malignant arrhythmia and
impaired level of consciousness.

2) Stable patient – Any patient who has normal vital signs, and absence of any
immediate threat of life or limb or vision and who is not in any acute
physiological distress.

3.0 ABBREVEATION

BLS: Basic Life Support

MO: Medical Officer

IPD: Inpatient Department

4.0 SCOPE

Medical officer and paramedical staff

The reason for transfer can be either medical or non-medical, including the transfer
required for getting diagnostic tests from external facility.

5.0 RESPONSIBILITY

Medical officer and paramedical staff

3|Page
 6.0 DISTRIBUTION

Medical officer and paramedical staff

 7. PROCESS DETAIL

 Transfer - out / referral policy of unstable patients:

Decision of transfer / referral is taken by Medical officer and the same is intimated to
patient and relatives with reasons.

Patients coming in for Emergency are provided with first aid treatment and stabilized, if
required before transferring, informed consent is taken then patient is transferred to
higher center.

Patient in life threatening situation (as decided by medical officer) is transferred in

ambulance with the best possible equipment accompanied by EMT and/or nurse and/or
Doctor depending on the condition of the patient. A doctor accompanies the patient while
transferring unstable patient.

All patients / Relatives who are being transferred to external facility (including transfers
from emergency) are provided with a case summary mentioning the status of patient,
significant findings and treatment given in the hospital. They should have monitoring data
received at the time of transfer.

Following procedure are followed for transfer of stable and unstable patients.
8.0 ACTIVITY and RESPONSIBILITY:

S. NO. STEPS RESPONSIBILITY

1 Patient shall be transferred to an identified external Medical Officer
healthcare facility, if the treatment needs of patient do not
match the scope of services provided by the PHC Palana.

2 Decision for transfer to other facility shall be taken by the Medical Officer
Medical Officer and same is noted on OPD/IPD case records
of the patient

3 In case of emergency, the concerned Medical Officer shall Staff nurse

be informed by the Staff Nurse.

4 Staff nurse shall take advice of Medical Officers before Staff nurse
transferring the patient.

4|Page
 5 Patient and/or relatives shall be explained about the reasons Medical Officer and
for transfer and their informed consent shall be taken. Staff Nurse

6 Patient/relatives shall be explaining about administrative Staff nurse

formalities as per the government scheme applicable.

7 In case of unknown patients, police shall be informed as per Medical Officer

MLC policy and procedure.(Phone /Written)

8 Case summary (or referral note) with mentioning Medical officer and
status o f patient, significant findings and treatment given staff nurse
shall be handed over to patient/relative/staff accompanying
the patient.

9 External facility where patient shall be transferred shall be informed Medical officer/staff
and their bed availability is confirmed / two way Communication. nurse

10 Communication shall be made for arrangement of ambulance as Medical officer/staff

per requirement. nurse

11 In Case of transfer of critically ill patient, ACLS Ambulance (108) staff coordinating the
shall be used. transfer `

12 Driver shall be informed to keep the PHC ambulance ready in Medical officer/staff
case of delay/ non availability of 108 . call for 108 shall be nurse
generated by staff nurse.

13 In case of conflict/nuisance be relative of patient ion hospital Medical officer/staff

security/police shall be contacted. nurse

8.0 ACTIVITY and RESPONSIBILITY

Following procedure is followed for transfer of stable patients
5|Page
 S.NO STEPS RESPONSIBILIT
Y
1 Decision for transfer to other facility is taken by Medical Officer
consultant or emergency duty doctor and same is noted on
OPD / IPD / Emergency case records of the patient
2 In case of emergency, the concerned Medical officer is Staff nurse
informed by the staff nurse on duty
3 Consultant’s advice is taken before transferring the Staff nurse
patient.
4 Patient and / or relatives are explained about the reason Medical Officer
of transfer and their informed consent is taken . Ask for
their preference of another hospital.
5 In case of unknown patients police is informed as per Medical Officer
MLC policy and procedure.
6 Case summary (or referral note) with mention of patient Medical Officer
status, significant findings and treatment given is
handed over to patient / relative / staff accompanying
the patient.
7 Communication is made for arrangement of ambulance Staff nurse
as per requirement

8 Driver is informed to keep the ambulance ready Medical Officer

9.0 REFERENCES:-

9.1Policy for Scope of Services (PHC PALANA /AAC/Doc no: 01.00)

9.2 Policy for admission (PHC PALANA /AAC/Doc no: 02.00)

10.0 LIST OF REFERRAL CENTRES

1. CHC - Vaso
2. CHC - Matar
3. Civil Hospital -Nadiad
4. Sub Distric Hospital- Kheda

6|Page