Referral system

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

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 affecting referrals ?a. Availability of qualified consultants.b. Physician specialty.c. Length of training.d. Unexplained findings.e. Uncertainty of diagnosisf. Patient characteristics.g. Reimbursement plan

Factors Affecting Referrals..

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 Process6. 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 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

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

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

Types of Referral

According to the case

Modern Classification

RoutineSeeking 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

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:

Modern Classification

IntervalPatient with MI admitted in hospital for a

period of then return for continuity of time

CollateralAs in diabetic patient with glaucoma referral

to ophthalmologist

Cross-referalSelf - Referral

Split-referralMulti-specialty in the same center.

4 Levels 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

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

Basic Principle of Referral

Merit in the referral process(need-objective).

PracticalNot 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..

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

Thank You!