This document discusses the referral system for delivering community health services. It defines a referral system as a mechanism that enables a patient's health needs to be comprehensively managed using resources beyond the facility they initially accessed care from. The objectives, definition, reasons for referral, characteristics, rationale, levels, types, components, perspectives, and issues of a referral system are described. The levels include primary, secondary and tertiary care facilities. The responsibilities of nurses in the referral process are also outlined.

1. DELIVERY OF COMMUNITY HEALTHSERVICES
(REFEERALSYSTEM)
PREPARED BY,
MRS,M.JOSEPHIDAYANA,
TUTOR.

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.

8. TYPES OF REFERRAL

11. 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.

12. 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.

13. 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.

14. 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

15. 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

16. 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.

17. 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.

18. 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.

19. 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.

20. RESPONSIBLITIES OF NURSE
 Informed consent
 Selection of consultant
 Acceptance
 Task performance
 Feedback

21. 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