Referral-Process System

REFERRAL
PROCESS/
SYSTEM
GROUP C
01
What is
nursing
referral?
● Referrals are contacts made by the nurse and other
members of the healthcare team in order to satisfy the
client's needs at the proper level of care and in the proper
setting.
● A referral system is defined as a system for transferring
cases that are beyond the technical competence of one
infrastructure to a higher-level infrastructure / institution
that has the technical competency and all other resources to
provide the desired health services.
● Independent nursing intervention
Reasons for Referral
★ To seek expert advice on the client.

★ Seeking additional or alternative
02 services for the client.

★ Seeking admission and client
management.
★ Seeking diagnostic and therapeutic
tools
Referral Form Outline
1. Patient information (name, address, age and sex)
2. Detail of referral doctor or hospital
3. Reasons for referral
4. Appointment urgency
5. Clinical problem
6. Significant prior history
7. Physical examination results
8. Investigational findings (photocopies of results should be
included)
9. Information about the given medication, treatment, and any
drug sensitivities
10. Expected result and desired follow-up
03
4 LEVELS OF
REFERRAL
4 LEVELS OF REFERRAL
PRIMARY SECONDARY TERTIARY

QUATERNARY
LEVEL OF LEVEL OF LEVEL OF
LEVEL OF CARE
CARE CARE CARE
PRIMARY LEVEL OF CARE
● Developed to urban and rural areas
● Referral site for the health worker and basic
health units
● Usually the first contact level between
community and other levels of health facility
● Provide management for common and minor
alignments requiring simple uncomplicated
interventions
● Center physicians, public health nurses, rural
health midwives, traditional healers.
● Barangay Health Station, Rural Health Unit
SECONDARY LEVEL OF CARE
● 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.
● Rendered by specialists in health facilities.
● Provide care for serious conditions that needs
technical interventions & inpatient care which are
not expected to available at P.H.C level.
● Municipal Hospital, District Hospital, Out-patient
Departments
TERTIARY LEVEL OF CARE
● 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
QUATERNARY LEVEL OF CARE
● The fourth and highest level of health care.
● These hospitals will consist of very highly
specialized referral units which together provide an
environment for multi-speciality clinical services,
innovation and research.
● People are referred to these hospitals by Provincial
Tertiary Hospitals.
● The types of quaternary care include: experimental
medicine and procedures and uncommon and
specialized surgeries
04
TYPES
OF
REFERRAL
1. Internal Referral
- It happens within the hospital, from one healthcare
employee to another.
- This type of referral is used to request an opinion or
suggestion, co-management, additional
management, or specialty care.
2. External Referral
- is a movement of a patient from one facility to another.
It can be divided into two:

1. Vertical, where a patient is referred from a lower to a
higher level of facility or the other way around.
2. Horizontal, where a patient is referred between similar
facilities in different catchment areas.
3. According To Case
A. Mandatory – in which the patient is likely to suffer
harm if not referred.
B. Elective- where the patient is unlikely to suffer harm
if not referred.
4. Modern Classification
A. Interval - patient with MI admitted in hospital for a period, then
returned for continuity of care
B. Split-Referral - Multi specialty in the same center
C. Collateral - Siabetic patient with glaucoma are referred to
opthalmologist
D. Cross referral - self referral
5. Routine Referral
- Seeking expert opinion for the diagnosis and
prognosis
- Seeking hospital admission and management for the
case
- Seeking further investigations
6. Emergency Referral
- To reach the expert on time before occurrence of the deterioration
with providing all expected information
7. Opportunistic Referral
- For expert opinion
- Admission
- Investigations
- Management
05
BENEFITS
OF
REFERRAL
BENEFITS
For the patient For the nurse
● Prompt diagnosis and
● Learning and training
management
● Gaining self confidence
● Save time, money and effort
● Increase
● Better outcome
communication between
Others the healthcare staff
● Prevents revenue leakage ● Improve the quality of
● Decreased lead times the patient’s
● Completing the loop of management
healthcare
● Enhanced healthcare
system
● Improved patient access
● Quality patient time
06
Steps of
Referral System
1 Establish a good relationship with the patient
2 Establish the need for referral

The need for referral may be one of the following reasons:
• To seek expert opinion regarding the client.
• To seek additional or different services for the client.
• To seek admission and management of the client.
• To seek use of diagnostic and therapeutic tools.
3
Set objectives for the referral
4
Explore resources availability
5 Patient decides to use or not use
6
Make pre-referral treatment
7
Facilitate, coordinate referral
8
Evaluate and follow-up
Example of Referral Form
You can enter a subtitle here if
you need it
07
PROCESS OF
REFERRING PATIENT
TO ATTENDING
PHYSICIAN USING
ISBAR
ISBAR
The “ISBAR” framework is used for effective communication. It aims to give
users the capacity to adapt, implement and evaluate an approach to
clinical communication around clinical handover in a health care setting.
The ISBAR framework is simple. It consists of 5 elements that focus a
conversation to relevant detail. This helps to focus the information and
eliminate irrelevant information. These elements are:
I – INTRODUCTION
• Who you are, your role, where you are and why you are communicating.
• Patient’s name, age, gender and location

ISBAR
S – SITUATION
• Briefly state the problem
• What is happening at the moment?
B – BACKGROUND
• What are the issues that led up to this situation?
• State client admission diagnosis and date of admission.
• State pertinent medical history.
• Provide brief summary of treatment to date.
• Code status (if appropriate)

ISBAR
A – ASSESSMENT/ ACTION ● Vital signs.
• What do you believe the problem
is?
● Pain scale.
• Use ABCDE approach
➢ Airway
➢ Breathing ● Is there a change from prior
➢ Circulation assessments?
➢ Disability
➢ Exposure
ISBAR
R – RESULT/ RESPONSE/ RECOMMENDATION/ RATIONALE
• What should be done to correct this situation
• Ask if HCP wants to order any tests or medications.
• Ask HCP if she/he wants to be notified for any reason.
• Ask, if no improvement, when you should call again.

Examples
Introduction:
> ‘This is Dr Nicko Cabillan calling from Masirom nga Malubak Street brgy
Trinidad, can I please discuss a patient with the Doctor in charge.
> Doctor in charge comes to the phone and identifies himself as Dr

Berguia, and Dr Cabillan identifies himself again.
> I would like to discuss one of my patients, Mrs Amorelle Borata, date of
birth 02/14/1985, Medical Record Number 1234567’
Examples
Situation:
> Mrs. Borata presented to our emergency department today at
1:05 pm with chest pain and shortness of breath. She is
markedly unwell and I suspect she is suffering with infective
exacerbation of chronic obstructive airways disease. We are
over capacity due to the COVID-19 Pandemic and do not
currently have resources to provide the level of care she
requires.’
Examples
Background:
> Mrs. Borata has a long history of chronic obstructive airways disease
and anxiety, with increasing hospital admissions over the last 5 years. Her
last hospital admission was 10/12/2021. She is a reformed smoker. Her
medication regime includes home oxygen, inhaled corticosteroid,
theophylline and a long-acting bronchodilator. Mrs Borata lives with her 5
daughters and 6 sons due to limitation in her activities of daily living. She
does not have an advanced care directive in place, but she does have
modifications in effect for her vital signs given the chronic nature of her
airways disease.
Examples
Assessment/Action:
> Mrs. Borata is extremely anxious and distressed. Her presentation for this
event is more severe than on previous occasions. An ECG was negative for
acute changes. On physical assessment her temperature is 37.1C, blood
pressure 120/80 mmHg, heart rate 99 bpm, respiratory rate 10 per minute,
oxygen saturations 90% on 4 liters of oxygen per minute via nasal specs.
She is unable to perform a peak flow reading. Inspiratory and expiratory
accessory muscle use is evident. This is consistent with acute
exacerbation of her chronic obstructive airway disease. Blood and sputum
specimens have been taken prior to commencement of an intravenous
fluid regime and antibiotics.
Examples
Recommendation:
> I recommend that Mrs Borata be retrieved to your institution for

definitive management of exacerbation of chronic obstructive airways
disease as soon as possible.’
SEMI URGENT EXAMPLE
I > Hi Dr Hanson, it’s Nurse Camille calling from Ward 1 looking after Julia
Diaz in bed 8.
S > She is admitted with pneumonia on a background of Type 2 diabetes.
B > Her BGL before lunch is 20.5mmol/L. She reports feeling a little dizzy
and nauseated, and she looks quite pale.
A > All her other observations are within normal parameters. She has had
her morning NovoRapid dose of 6u and is not due any more insulin until
2000hrs.
R > Would you be able to review her before lunch? Please contact me as
soon as possible on 811. Thank you..
NON-URGENT EXAMPLE
I > Hello Good morning, is this Social Work department? it’s Nurse Catalina
calling from Ward A at Philippian’s Hospital.
S > I’m the nurse looking after Jazmin Cesar.
B > She lives alone and is currently unemployed.
A > She has reported to me today stating she is experiencing financial

difficulties at present, and would like to speak to someone from Social
Work to see what assistance is available to her.
R > We anticipate that she will be discharged early next week once she is
medically stable. Please call me on 811. Thank you.
EXAMPLE OF BEDSIDE HANDOVER
I > “Nurse Sophia, this is (checks wristband) Mitz Liza, hospital number is 56985 DOB
1/3/1950.
S > She has been admitted to us with a L fractured NOF post mechanical fall at home.
B > She has a history of AF on Warfarin, OA and dementia. She has a high risk for falls
and has a documented allergy to Morphine which causes hallucinations. She has a
documented advanced care directive.
A > Her pain has been well controlled with the femoral nerve block from this morning,
and regular analgesia as per the medication chart. Her vital signs have been within
normal limits throughout the shift. She is currently fasting for theatre this evening,
consent has not been done yet – the treating team are awaiting her MPOA to come in
and meet with the team. She has a 12/24 bag of N/Saline running.
R > She will need an IDC inserted and a theatre pack completed prior to going to OT. Did
you have any questions in regards to Mitz’s care?”
FIN

Referral-Process System

Uploaded by

Copyright:

Available Formats

Referral-Process System

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Referral-Process System

Uploaded by

Copyright:

Available Formats

REFERRAL

★ To seek expert advice on the client.

02 services for the client.

PRIMARY SECONDARY TERTIARY

It can be divided into two:

2 Establish the need for referral

• Patient’s name, age, gender and location

• Briefly state the problem

• What is happening at the moment?

• What are the issues that led up to this situation?

• State client admission diagnosis and date of admission.

• State pertinent medical history.

• Provide brief summary of treatment to date.

• Code status (if appropriate)

• What should be done to correct this situation

• Ask if HCP wants to order any tests or medications.

• Ask HCP if she/he wants to be notified for any reason.

• Ask, if no improvement, when you should call again.

> Doctor in charge comes to the phone and identifies himself as Dr

> I recommend that Mrs Borata be retrieved to your institution for

S > She is admitted with pneumonia on a background of Type 2 diabetes.

S > I’m the nurse looking after Jazmin Cesar.

B > She lives alone and is currently unemployed.

A > She has reported to me today stating she is experiencing financial

You might also like