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  2. OBJECTIVES At the end of the class students are able to  Define referral system.  Reason for referral.  Rationale for referral.  Characteristics of referral system.  Levels of referral system.  List the types of referral system  Components, perspectives and issues , responsibilities.
  3. DEFINITION A referral system is a mechanism that enables a patient’s health needs to be comprehensively managed using resources beyond those available at the location they access care from, be it in a community unit, dispensary, health centre or a higher level facility
  4. REASONS FOR REFERRAL  To seek expert opinion.  To seek additional or different services.  To seek admission and management  To seek use of diagnostic& therapeutic tools  For continuity of care
  5. CHARECTERISTICS  Patient should be given optimal care at the right level, right time and right cost.  Optimal and cost efficient utilization of health care system.  Optimal and appropriate utilization of specialist services for needy persons  Optimal utilization of primary health care services. 
  6. RATONALE OF REFERRAL SYSTEM  Most common, most complicated and life threatening diseases requires different levels.  Maximize limited resources & avoid duplication of services.  Ensures a close relationship between all levels of the health system.  Helps people receive the best possible care closes to home
  7. Cont…  Support primary health centers.  Helps to build capacity.  Reduce the high proportion of customers seen at the outpatient clinics at 2nd facilities.
  9. LEVELS OF REFERRAL SYSTEM Primary level of care:(PHC)  Developed to urban and rural areas  Referral site for the village health worker & basic health units  Usually is the 1st contact level between community & other levels of health facility.  Provide management for common & minor alignment requiring simple uncomlicated intervention.
  10. Secondary level of care:(District Hospital)  Referral site for the primary care facilities  Given by physicians with basic health training.  Usually given in health facilities either private owned or government operated  Rural hospitals, state general hospital, out- patient department are main sites of care.  Rendered by specialists in health facilities.
  11. Tertiary level of care: (Superspecality Hospitals)  Referral site for the secondary care facilities.  Can be medical centers, regional, provincial hospitals and specialized hospitals.  Provide care for complicated, uncommon and serious diseases requiring highly specialized or high technology interventions.
  12. REFERRAL SYSTEM IN INDIA  Sub centres(SC)  Primary Health Centres(PHC)  Community Health Centres(CHC)  Sub District Hospitals  District Hospitals  Tertiary Level Facilities In Medical College Hospitals  Super Speciality Hospitals In India
  13. COMPONENTS  Can be adjusted relevant to the local situation.  Components can include:  health system  Referral process at the 1st level of care  Referral activities  Referral process at 2nd or tertiary level  Supervision and capacity building
  14. PERSPECTIVES & ISSUES OF ESTABLISHING REFFERAL  HEALTH SYSTEM ISSUES  Service providers & quality of care.  Performance expectations & involvement of organization.  All service providers are expected.  Follow the agreed protocols of care.
  15. REFERRAL PROCESS AT 1ST LEVEL:  During visits of H.C, it is important that the health worker  For proper performance the health workers  Protocols need to include  Making decision to refer comes after the gathering and analyzing relevant information using protocols as a guide  Deciding to refer dose not mean that the health workers is inadequate or bad.
  16. REFERRAL ACTIVITES  adoption of standardized referral forms to ensure equality whenever a referral is initiated  patients referred out should be accompanied.  Carefully filled referral card cab helps to get timely attention at the receiving facility.
  17. REFERRAL PROCESS AT 2ND OR 3RD LEVEL:  The receiving facility  The supervisor SUPERVISION AND CAPACITY BUILDING:  Facility managers & supervisors at all levels should monitor all referrals to & from facilities.  Supervisors should discuss referred cases.
  18. RESPONSIBLITIES OF NURSE  Informed consent  Selection of consultant  Acceptance  Task performance  Feedback
  19. BIBLIOGRAPHY  Kamalam. S, “ESSENTIALS IN COMMUNITY HEALTH NURSING PRACTICE”, 1st edition, 2008 jaypee brothers, new Delhi, page no, 105-110  B. T. Basavanthappa “COMMUNITY HEALTH NURSING”, 1st edition, 2008 jaypee brothers, Mumbai, page no 30- 35  Kasturi sundar rao, “community health nursing”, BI publications;265-270