The document discusses the referral system in healthcare. It defines referral as transferring responsibility of care from one healthcare professional to another or to the community due to inability or limitations to provide necessary care. The purposes of the referral system are to provide comprehensive care within technical competencies, help people access specialized services, and prevent overloading of specialized institutions. The referral process is vertical, allowing cases to move between different levels of care. Requirements for an effective referral system and roles of community health nurses are also outlined.

1. REFERRAL SYSTEM
DR.ANJALATCHI MUTHUKUMARAN
VICE PRINCIPAL
ERA COLLEGE OF NURSING , ERA UNIVERSITY
LUCKNOW 226003

2. Introduction
• INTRODUCTION:-
• Referral is a process by which a health worker transfer
the responsibility of care to another health professionals
or social worker or to the community in response to its
inability or limitation to provide the necessary care.
• Referral is a two way process and ensure that a
continuum of care is maintained to patients.
• DEFINITION:-
• Referral system, involves sending a patients to another
physician for ongoing management of specific problems.

3. Purpose
• PURPOSE OF REFERRAL SYSTEM:-
• To provide need based comprehensive care within
the technical competencies & resources at each level
of primary health care infrastructure efficiently and
effectively.
• To help people avail specialized services available at
higher level institution which are beyond their
reach.
• To streamline the appropriate use of PHC
infrastructure and specialized services in order to
prevent overloading of specialized institution by
direct uses.

4. Process of R.S.
• REFERRAL PROCESS:-
• The referral system is vertical in nature.
• The cases can be referred from villege health post to
SC/PHC, from SC to PHC/CHC and from PHC to
CHC/secondary or tertiary level hospital and from
CHC to secondary or tertiary level hospital.
• Provision is made for bypassing 1 or 2 level
depending upon the nature and seriousness of cases
so that required medical and nursing care can be
given on time to the case and mortality and
morbidity can be prevented and controlled.

5. Cont..

6. Requirements for R.S.
• THE REFERRAL UNITS OF PHC SYSTEM NEED TO:
• Well trained required number of professionals, medical
equipment & supplies, organization structure etc.
• Continuing training, guidance & supervision of community
health workers.
• Guidance on sanitary measures & to disseminate information
on disease control methods. Conduct health education
sessions.
• Provide logistic supports in terms of equipment & supplies
required at PHC.
• Establish liaison & functional relation with other sectors
involved in social and economic development.
• Organize transportation facilities for cases to be referred.

7. SELECTION FOR REFERRAL
• The very serious patient requiring immediate
medical care & treatment.
• Patients presenting serious signs & symptoms.
He/she may not be sick but requires immediate
referral.
• When special diagnostic procedures are
required for diagnosis.

8. CASES REUIRED TO IMMEDIATE REFERS.
• THE CASES WHO MAY REQUIRE IMMEDIATE REFERRAL ARE
AS UNDER:
• Cases presenting any problem which cannot be handled during
pregnancy, labor and post natal period.
• Severe diarrhea with dehydration or not responding to treatment.
• Pain in abdomen and vomiting with or without presence of bowel
sounds.
• Heart burn, dyspepsia, dysphagia, and maleana etc.
• Continuous cough with or without sputum, haemoptysis. Fever with
stiff neck.
• Fever not responding to treatment.
• Fever with severe joints pain, rashes, bleeding under the skin.
• Breathing difficulty while walking, sleeping, doing physical work.
• Jaundice, loss of appetite.
• Convulsions with fever.

9. ADVANTAGES OF R.S.
• Beneficial to patients because they receive effective care at
the primary level which is near to their home.
• Beneficial to health workers because they are able to take
care of patients which are within their level of competence
and are not frightened to handle difficult cases because they
can refer them to higher level centers and referral units.
• Beneficial to management because it is economical as highly
trained and highly paid doctors, nurses and other
professionals take care of patients with serious and complex
problems at higher level referral unit and patients with
simple and minor problems are taken care at much low cost
by health workers at lower level.

10. ROLES OF COMMUNITY HEALTH NURSE.
• Observe and collect information about the illness, trauma, related
situation, factors etc.
• Identifies the nature of illness/emergency and its seriousness.
• Provides immediate treatment care within her competence, standing
orders and resources available.
• Assures the casualty/family members/ any other person accompanying.
• Explains about the seriousness of the problem situation and need for
reference to the casualty.
• Fills up the referral form as desired and hands over the same with related
documents to be given to health professionals in referred health center.
• Arranges for transport of the patient according to feasibility as soon as
possible.
• May do the telephonic consultation or provide information to referred
health center.

11. BIBLIOGRAPHY
• Basavanthappa BT. Community health nursing .
3rd edition. Jaypee the health sciences publisher.
New delhi panama. Volume 2nd . 2016. Page no.
934-939
• Saxena RP.text book of community health
nursing.2nd edition.lotus publisher. Ladowali
road j. jalandhar city.2018. page no.206-208.