1. Referral Process
Astha K Patel
C.M.Patel College of Nursing
Astha K. Patel

2. Meaning
• The practice of sending a patient to another
program or practitioner for service(Treatment)
or advice which the referring source in nor
prepared or able to provide.
Astha K. Patel

3. Definition
• The system which the patient is sent
from the health centre with fewer
amenities to the health institution or
treatment centre, which has more
resources, facilities and amenities is
called Referral system.
Astha K. Patel

4. Definition
• The referral process is a systematic problem
solving approaches involving series of action
that helps clients use resources for the
purpose of resolving needs.
Astha K. Patel

5. Importance of Referral
• Providing diagnostic services to patient &
community
• Providing specialist’s service to the patient
• Preventing further complications
• Provide appropriate treatment
Astha K. Patel

6. Principles
• Should be based on needs of patient.
• It should be timely
• It should be co-ordinated with other agencies.
• Patient have right to refuse the referral/flexible
• The client should use referral services in
effective & Efficient Manner.
• It should be individualized to the client.
• The referral should incorporate the client and
family into planning and implementation.
Astha K. Patel

7. Goal
• Improve health status of Patient.
Astha K. Patel

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9. Selection of patient for Referral
First Group/Fatal
Patients
Second Group/Serious
Patients
Third Group/General
Patients
Astha K. Patel

10. First Group / Fatal Patients
• Such patient cannot survive despite the best
treatment made available to them.
• So, to send them for Rx is waste of time &
money, hence it is better to give them
appropriate Rx at the health centre itself with
available resources.
Astha K. Patel

11. • It is essential for the relatives of the patient to
understand that owing to his fatal condition.
• It will not be beneficial to send the patient for
referral.
Astha K. Patel

12. Second group / serious patients
• Condition of such patient is considered serious
but immediate treatment can save their lives.
• Before sending them for referral, attempts
should be made to reduce the seriousness of
condition and only after that they should be
sent for referral.
Astha K. Patel

13. Third Group/ General Patient
• Though the d’se may be serious in such
patient still the condition of the patient is
found to be normal.
• After surgery or in case of diagnosis is not
possible or for use of some special technique
patient can be sent to a big or specialist
hospital for consultation.
Astha K. Patel

14. • Thus, on the basis of
Patients condition
Type of d’se
Treatment
Diagnosis
Latest technique of treatment
Patient can be prepared for referral system.
Astha K. Patel

15. Types of Refferal
Inter-disciplinary
•Allopathy-Allopathy , AYUSH-AYUSH
Intra-disciplinary
•Allopathy-AYUSH
Astha K. Patel

16. Types of Referral
Interval Collateral
Cross Split
Astha K. Patel

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19. Levels of Referral System
Primary Level
Secondary Level
Tertiary Level
Astha K. Patel

20. >ASHA,
AW,VHG
> SC
>PHC
>CHC
>Rural
Hospital
> District
Hospital
> Teaching
Hospital
>Speciality
Hospital
Astha K. Patel

21. Primary Level
• First contact level with health personnel and
health centre.
• It may be called dispensaries.
• Health centre which serve a define
community or area normally at a village level.
• Ex. – ASHA, VHG, AW, Sub centre & PHC
Astha K. Patel

22. Secondary Level
• Provide specialize health care services for 24
hours.
• Rendered by specialists in health facilities.
• Ex. – CHC & District Hospital
Astha K. Patel

23. Tertiary Level
• A more sophisticated hospital providing
multispecialty medical care with technical
competence.
• Provided complicated cases and intensive care.
• Located in a cities.
• It also involved teaching hospital.
Ex.- Apollo, AIIMS, CMC Vellore, Cims, HCG, Sal,
Shalby etc…
Astha K. Patel

24. PRIMARY
LEVEL
SECONDARY
LEVEL
TERTIARY
LEVEL
ASHA/AW/VHG
SUB CENTRE
PHC
SPECIALITY HOSPITAL
DISTRICT HOSPITAL
TEACHING HOSPITAL
CHC/RURAL HOSPITAL
Astha K. Patel

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26. Referral form/slip
• Name of health centre/hospital
• Stamp of hospital
• Name of referral unit
• Name of patient
• Age & sex
• Religion
• Occupation
• Present diagnosis
• Case history in short
• Description of Rx given
• Date of sending for referral
• Enclosed papers
• Name of sender
• Designation Astha K. Patel

27. FIRST REFERRAL UNIT
CHC is the first referral Unit (FRU).
Astha K. Patel

28. Critical Determinants of a FRU’s
• 24-hour delivery services including normal
and assisted deliveries
• Emergency Obstetric Care including surgical
interventions like Caesarean Sections and
other medical interventions
• New-born Care
• Emergency Care of sick children
• Full range of family planning services
including Laproscopic Services
Astha K. Patel

29. • Safe Abortion Services
• Treatment of STI / RTI
• Blood Storage Facility
• Essential Laboratory Services
• Referral (transport) Services
Astha K. Patel

30. 5 specialities
• Physician
• General surgeon
• Obstetric & Gynaecologist
• Paediatrician
• Anesthesiologist
Astha K. Patel

31. Points to be consider while selecting
the facility
Infrastructure needs
• A minimum bed strength of 20-30 and
• A fully functional operation theatre equipped
for undertaking anesthetic and emergency
surgical procedures.
• A fully operational Labour Room.
Astha K. Patel

32. • An area equipped for New-born Care in the
Labour Room and also in the ward.
• A functional laboratory with facilities for all
essential investigations.
• Blood storage facility as per the guidelines
issued by Govt. of India (GoI).
• 24-hour water supply.
• Arrangements for waste disposal
Astha K. Patel

33. • Regular electricity supply with back-up
arrangements to ensure uninterrupted supply
• Telephone connection.
• Ambulance (owned or arranged through local
hiring).
• Selection of sites
Under the RCH Programme funds
were provided to CHCs and district hospitals.
Astha K. Patel

34. Equipment Kits Supplied Under CSSM
Programme
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38. Barriers in Referral services
Astha K. Patel

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