Unit 7 referral system part 2
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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.
![FUNCTIONS OF FIRST REFERRAL UNIT[FRU]
• Surgical function
• Medical treatment function
• Blood transfusion function
• Manual Functioning
• Anesthetic function
• Obstetric and neonatal care function](https://image.slidesharecdn.com/unit7referralsystemp2-210519062451/85/Unit-7-referral-system-part-2-6-320.jpg)
![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]](https://image.slidesharecdn.com/unit7referralsystemp2-210519062451/85/Unit-7-referral-system-part-2-8-320.jpg)
Unit 7 referral system part 2
- 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