This document discusses India's 3-tier referral system for healthcare and the nurse's role within it. It describes the levels from village to tertiary care and the purposes of referrals for early treatment, cost-effectiveness, and education. The referral process involves selecting cases based on severity, preparing documentation, informing the receiving unit, transporting the patient, and providing feedback. Nurses are responsible for communication, monitoring patients during transfer, collecting records, and properly handing off care. The system aims to efficiently direct patients to the appropriate level of specialized treatment.

1. REFERRAL SYSTEM
UNIT 7/ PART 2/CHN
GNM

2. TOPICS
• Referral Services Available
• Interdisciplinary referral system
• Role Of Nurse In Referral Services

3. REFERRAL SERVICES AVAILABLE
• 3 tier system considering 3 level of prevention
• each level planned to cater specific type of health needs of the
client
• WHO identified provision of referral system as major
supportive activities of primary health care
• Referral system established in such a way to refer case from
primary level to secondary level or tertiary level based on the
clients needs
• Primary health center is the 1st medical reference point in
health system chain
• Each system performs its function for which it is established

4. STATE LEVEL HOSPITALS
COMMUNITY HEALTH CENTER
PRIMARY HEALTH CENTER LEVEL
SUBCENTER LEVEL
VILLAGE LEVEL
DISTRICT HOSPITALS
FIRST
REFERRAL
UNIT
VILLAGE
HEALTH
GUIDE
PRIMARY
LEVEL OF
CARE
SECONDARY
LEVEL OF
CARE
TERITIARY
LEVEL OF
CARE
REFERRAL SYSTEM

5. PURPOSES
• For early diagnosis and treatment of case under specialist care
• Cost effective system
• Reduces the duration of stay of patient in the hospital
• Limit the progress of the disease
• Prevents complication by starting appropriate timely care
• Teaching the nursing personnel for reviewing of patient sent
for referral

6. FUNCTIONS OF FIRST REFERRAL UNIT[FRU]
• Surgical function
• Medical treatment function
• Blood transfusion function
• Manual Functioning
• Anesthetic function
• Obstetric and neonatal care function

7. STEPS IN REFERRAL
✔ Selection of cases to be referred
✔ Types of cases for referral
✔ Preparation of cases
✔ Shifting of cases to the referral unit
✔ Feedback

8. 1. Selection of cases
• It depends on the condition of the patient and facilities
available in health center. The 3 group of cases are:
✔ First group or fatal cases. [prognosis of case is poor &
patient has less survival rate, patient relatives counseled
on why not referred]
✔ Second group or serious patients.[patient with serious
condition , immediate treatment could save life of patient]
✔ Third group or common patients.[routine cases for
diagnosis, treatment & consultation by specialist]

9. 2.Types of cases for referral
• Any life threatening cases like severe hemorrhage , shock,
cyanosis, head injury, multiple fracture
• Severe chest pain
• Coma due to any cause
• Acute abdomen, intestinal obstruction, hemoptysis,
hemetemesis , black colored stool
• Convulsion more than 1 attack
• Severe body pain for more than 3 days
• Hyperpyrexia not responding to treatment

10. • Severe burns
• Poisonous cases
• Suspected cases of tetanus
• Frequent vomiting, absence of bowel sound, severe diarrhea
and dehydration, not responding to treatment
• Obstructed labor, complicated deliveries
• Any other fatal or life threatening condition.

11. 3. Preparation of cases to be referred
• Explain reason for referral to patient and his relatives.
• Fill the referral form and get it signed by referring doctor,
once the doctors written orders are ready.
• Hand over patients valuables and belonging to patient relatives
• No dues collected by patient
• Keep all medical documents, investigation reports, X Ray ,
ECG to be send along with patient

12. REFERRAL FORM:
Name of the Health Center /Hospital
Referral Registration No:……………………………......... Date:…………………………..
Name of the Patient:……………………………. Date & Time of Admission:……………..
Fathers / Husbands/Guardians Name:………………………………………………………..
Age:…………. Sex:……………. Religion:…………………… Occupation:……………..
Permanent Address:…………………………………………………………………………..
Telephone of next of kin:……………………………………………………………………..
Present diagnosis:…………………………………………………………………………….
Case history in brief:…………………………………………………………………………
Description of treatment:…………………………………………………………………….
Reason for referring:…………………………………………………………………………
Enclosure and papers like:
• Case File
• X Ray
• Investigation Reports
Sign of the Referring Doctor
( Name in Capital Letter)
Designation
Seal of the Health center

13. 4. Shifting of cases to the referral unit
• Inform the referral unit telephonically briefing the condition of
the patient, reason for referral (to keep the bed , drugs &
emergency equipment ready and to inform the concerned
specialist doctor about time of patients arrival)
• Patients are shifted via ambulance, assisted by emergency
doctor and nurse according to severity of case.
• Accompanying staff nurse hand over patient to concerned staff
in referring unit with his vital parameters , treatment chart and
case file with referral form and take the signature of the
person.

14. 5.Feedback
• It’s a 2 way process and retention of patient in referral unit is
as brief as possible.
• As the investigations are done, proper diagnosis, specialist
consultation , the line of treatment decided to be carried out in
parent health center.
• Patient returned to parent center once patient responding to
new line of treatment

15. INTERDISCIPLINARY REFERRAL SYSTEM
• Type of referral system in which, patients referred to another
therapy if the patients treatment and diagnosis was not
satisfied with one type of therapy.egs: From allopathy to
AYUSH

16. ROLE OF NURSE IN REFERRAL SYSTEM
• Inform the referring unit telephonically prior shifting
• Explain patient and his relatives about reason for referral to
higher level of health care
• Close monitoring of patient vital parameters to make sure
when the patient is fit to be shifted or to confirm any
emergency treatment required till the condition is stable.
• Collect all patient documents to be sent along with patient.
• Check the referral form whether filled completely and signed
by referring doctor with brief history of case
• Hand over patients valuable belonging to patient relatives

17. Contd..
• If patient to be shifted with O2, IV life line drip, nurse should
assist the patient to referring unit
• Take clear written instruction from referring doctor, to be
carried out if emergency arises on the way
• Hand over the patient , his documents and take signature of
person who taken over the patient in presence of some witness
• All nursing personnel in SC , PHCs , CHSs and district
hospital should have knowledge about referral system