Referral system Definition

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.
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.
NB. Referral does not mean transferring
responsibility. But, it’s Sharing
responsibility in patient care.
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 .
 Factors
Factors Affecting
affecting referrals ? 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
 Referral Process
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.
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
 STEPS OFofTHE
Steps REFERRALProcess
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.
Benefits Benefits
of referral: 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
 Referral letter outline
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.
 Types of Referral

According to Modern
the case Classification
 Types of Referral
Routine Emergency
Seeking expert opinion for To reach the expert on time before
diagnosis and prognosis occurrence of deterioration with providing
all expected information in referral letter.

Seeking Hospital admission and

management for the case. Opportunistic

Seeking further investigations - For Expert opinion - Admission

- Investigations - Management
It can be classified according to the case to:

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.
 Modern Classification

Interval Collateral
Patient with MI admitted in hospital for a As in diabetic patient with glaucoma referral
period of then return for continuity of time to ophthalmologist

Split-referral Cross-referal
Multi-specialty in the same center. Self - Referral
4 Levels of Referral
• From family physician primary health care to hospital specialist.
1st

• From specialist to another specialist.

2nd

• From junior specialist to senior specialist.

3rd

• from general hospital to specialized hospital

4th
 Disadvantages of
Self Referral and Direct access to hospital

Loosing
Lack of way
Increase Wastage of
Insufficient Continuity between
care
waiting resources
and follow- hospital
time at all levels
up different
sectors
Basic Principle of Referral

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

So, it’s not an end, but just a beginning!