REFERRAL

SYSTEM

PRESENTED BY:
NEHA PUROHIT
 REFERRAL SYSTEM

Definition:

“ Referral is a process of directing someone to another

source of assistance. Referral is the act or instance of
sending or directing someone for treatment, aid,
information or a decision”.
 REFERRAL AND THE CONTINUUM OF CARE

• Referral can be an important tool in ensuring a

continuum of care for clients by helping them to access
all the relevant services available to address their
physical, psychological and social needs.
 PRINCIPLES
• The referral should meet the needs and objectives of the
clients and should be necessary and appropriate.
• The client should be able to use the referral in an
efficient, effective manner.
• The referral should be timely.
• The referral should be coordinated with other activities.
• The referred should have the right to refuse the referral.
 THE NURSE SHOULD BE AWARE OF
• Address and telephone number of the client.
• Client’s age, sex and marital status.
• Name of family members.
• Source of medical care and health history.
• Financial status and records.
• Reasons for seeking referral.
 THE BASIC STEPS OF THE REFERRAL PROCESS

• Establish a working relationship with the client.

• Define the need for referral.
• Set objectives for the referral.
• Explore resource availability.
• Client decides to use or not use referral.
• Facilities and follow up.
 REFERRAL SYSTEM: LEVELS OF HEALTH CARE

• LEVEL 1 : Primary Health Care Clinic

• A Primary Health Care Clinic is the first step in the
provision of health care and offers services such as
immunization, family planning, anti-natal care,
treatment of common diseases, treatment and
management of Tuberculosis, HIV/AIDS counselling,
and other services.
• If the clinic cannot assist the client will be referred to
Community Health Centre.
 COMMUNITY HEALTH CARE CENTRE
• A Community Health Care Centre is the second step in
the provision of health care but can also be used for first
contact care.
• A Community Health Care Centre offers similar
services to Primary Health Care Clinic with the addition
of 24 hours maternity service, emergency care and
casualty and short stay wards.
• The Community Health Care Centre will refer the client
to the District Hospital when necessary.
 DISTRICT HOSPITAL
• This is the third step in the provision of health care.
• These hospitals will normally receive referral from and
provide generalist support to community health centres
and clinics such as diagnostic, treatment, care,
counselling and rehabilitation services.
• Clinical services include Surgery, Obstetrics &
Gynaecology, Out-Patients Department, Medicine,
Paediatrics, Mental Health, Geriatrics, Casualty and
Clinical Forensic Medical Services amongst other
services.
• These hospitals receive referrals from the Community
Health Centres.
 LEVEL 2 - Regional hospital
• This is the second level of health care.
• These hospitals will normally receive referral from and
provide specialist support to a number of district
hospitals.
• If the Regional Hospital cannot help they will refer to
the Provincial Tertiary Hospital.
 LEVEL 3 - Provincial Tertiary Hospital
• These hospitals will receive referral from and provide
sub-specialist support to a number of regional hospitals
and is the third level of health care.
• These hospitals are staffed by specialists and offer
services such as neurosurgery, neurology, Plastic &
reconstructive surgery, Cardiology, Urology, Paediatric
surgery, Psychiatry, Occupational health and
Orthopaedics amongst other services.
• If a Provincial Tertiary Hospital cannot help they will
refer to a National Central Hospital.
 LEVEL 4 - Central Hospitals
• The fourth and highest level of health care is Central
hospitals.
• These hospitals will consist of very highly specialised
referral units which together provide an environment for
multi-specialty clinical services, innovation and
research.
• People are referred to these hospitals by Provincial
Tertiary Hospitals.
 BARRIERS TO REFERRAL PROCESS
• Resource barriers,
• Attitude of health care professionals,
• Physical accessibility of resources,
• Cost of resources,
• Client barriers, lack of knowledge about available
resources lack of understanding regarding need for
referral client, cultural factors, finances Accessibility.
 Referral Hospitals in Health Care

• Referral hospitals include secondary and tertiary-level

hospitals designed to provide specialized care to patients
referred from lower levels of the health system.
 Specialist services in secondary (regional) hospitals

• Internal medicine.
• General surgery, including emergency care.
• Obstetrics and gynaecology.
• Paediatrics; and Other specialties, such as mental health
care, depending on the pattern of medical practice in the
country.
 Tertiary hospital services
• Full intensive care unit;
• Specialized burns, intensive care unit;
• Specialized diagnostics, such as CT scans and MRIs
(advanced medical imaging technologies);
• Specialized surgery such as neurosurgery;
• Other medical specialties such as gastroenterology or
oncology.
 The Role of Referral Hospitals
• Offering Advice and Support to Lower-Level Health
Facilities.
• Providing quality assurance and improvement.