Ahmad, Nurul Fatma - Referral System

Integrated Health System:
Referral System
NURUL FATMA DIYANA BINTI AHMAD, 2019-48807
REFERRAL ?
What is referral system?
The set of activities undertaken by a health care

provider or facility in response to its inability to
provide the necessary medical intervention to
respond to a patient’s need.
REFERRAL SYSTEM
Mechanism whereby clients or local health
networks are managed and “moved” between
various components of that network.
TYPES OF REFERRAL
Your great subtitle in this line
EXTERNAL vs INTERNAL
BASIS OF REFERRAL
STEP UP CARE
STEP DOWN
FAMILY REQUEST.
CARE
SAME LEVEL
CARE
FRAMEWORK FOR HEALTH REFERRAL
Your SYSTEM
great subtitle in this line
State/ Regional Hospital
District Hospital District Hospital

without specialist with specialist
Primary Care Providers (Clinics)

RESPONSIBILITY OF DESIGNATED REFERRING (SENDING)
INSTITUTION
DECIDE WHETHER PATIENT NEEDS TO BE

TRANSFERRED
ENSURING SAFE AND TIMELY

TRANSPORTATION
RESUSCITATION AND STABILIZATION
COMPETENT PATIENT OR REPRESENTATIVE

SHOULD BE INFORMED OF THE REFERRAL
RESPONSIBILITY OF DESIGNATED REFERRAL (RECEIVING)
INSTITUTION
RECEIVING, ARRANGING FOR PROPER

EXAMINATION AND ADMISSION
ACCOMODATING OR FINDING BED FOR

PATIENT
PROVIDING FEEDBACK TO THE REFERING

HOSPITAL
TRANSPORTATION OF PATIENT BACK TO

THE REFERRING INSTITUTION
Professional Roles
DOCTOR / SPECIALIST
Direct appropriately Discuss situation with

trained staff to accompany primary team & referral
hospital
Make decision to transfer
Ensure relevant following consultation
medical documentation
fully completed
Ensure receiving unit

has full details
Inform next kin
Liase with staff at of the decision
receiving unit
NURSING STAFF
Ensure arrangement Discuss transfer arrangement

are made for the transfer of with receiving hospital
patient’s valuable
Contact ambulance control
Ensure all appropriate
Document is completed
Obtain time of transfer
Being available to
Provide nursing support
Identify nursing staff
Ensure full explanation Required to accompany
given to patient
NURSE / PARAMEDIC ACCOMPANYING PATIENT
Ensure patient & staff safety
Ensure details of patient

Given to the receiving Ensure ambulance is
unit driven safely
Monitor and record

patient’s condition
Ensure necessary equiptment
Ensure appropriate documentation and medication are available
accompanies patient
Referral Records
12
REFERRAL RECORDS
Referral letter X-rays Lab Reports Medication Other Information

Referral Letter Feedback Letter
14
Transfer & Transport
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1. DECISION TO TRANSFER & COMMUNICATION
Key Elements of Patient Transfer
Decision to transfer
- Exposure of patient and
staff to additional risk and
additional expenses for
relatives and hospital
Communication
- Sharing of complete
information
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2. PRE TRANSFER STABILISATION & PREPARATION
17
3. MODE OF TRANSFER
18
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4. ACCOMPANYING PATIENT
Patients who can be managed at the level of ward - usually not required to be
0 accompanied by any specialised personnel
Patients who are at risk of deterioration in their condition - paramedic or a

1
trained nurse
Patients who require observation or intervention for failure of single organ

2 system - trained and competent personnel
Patients with requirement of advanced respiratory care during the transport

3 with support of at least two failing organ systems - competent doctor with a
nurse & paramedic
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5. EQUIPMENT, DRUGS, AND MONITORING
Equipment Drug Monitoring

Airway Management Muscle Relaxants Electrocardiogram Monitoring
Oxygenation Sedatives Non-invasive blood pressure

Ventilation Analgesics Oxygen Saturation
Haemodynamic Monitoring Inotropes End-tidal Carbon Dioxide
Resuscitation Resuscitation drugs Temperature
6. DOCUMENTATION
Key elements of patient transfer
Patient’s condition, reason

for transfer
Names and designation of
referring and receiving clinicians
Details and status of vital

signs before transfer
Clinical events during the

transfer and the treatment given
AND CHALLENGES
23
State hospital (1)
Major Specialist Hospital (4)
Minor Specialist Hospital (6)
Special Institution (1)
Hospital without Specialist (11)
24
State hospital (1)
25
State hospital (1)
26
State hospital (1)
27
STOP??
Stop?
28
Referrence:
1. Guideline for Referral and Transfer of Patient between MOH Hospital.
Director General of Health Circular 2/2009. Medical Development Division.
Ministry of Health Malaysia. Mei 2009.
2. Guideline for Flying Doctor Service in Sabah and Sarawak, Family Health
Development Division. Ministry of Health Malaysia. 2015.
3. Health Referral System Manual, Integrated Community Health Services
Project, Department of Health, Republic of the Philippines.
4. Guideline for Inter Facilities Transfer Across Malaysia and Thailand Border
2017.
5. Recommendations of Minimum Standards for Inter-facility Transport of the
Critically Ill Patients, College of Anaesthesiologists, Academy of Medicine of
Malaysia.
6. Referral Systems – A Summary of Key Processes to Guide Health Services
Managers, World Health Organisation. Available at:
https://www.who.int/management/facility/referral/en/
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Integrated Health System:

The set of activities undertaken by a health care

District Hospital District Hospital

Primary Care Providers (Clinics)

DECIDE WHETHER PATIENT NEEDS TO BE

ENSURING SAFE AND TIMELY

RESUSCITATION AND STABILIZATION

COMPETENT PATIENT OR REPRESENTATIVE

RECEIVING, ARRANGING FOR PROPER

ACCOMODATING OR FINDING BED FOR

PROVIDING FEEDBACK TO THE REFERING

TRANSPORTATION OF PATIENT BACK TO

Direct appropriately Discuss situation with

Ensure receiving unit

Ensure arrangement Discuss transfer arrangement

Ensure patient & staff safety

Ensure details of patient

Monitor and record

Referral letter X-rays Lab Reports Medication Other Information

Patients who are at risk of deterioration in their condition - paramedic or a

Patients who require observation or intervention for failure of single organ

Patients with requirement of advanced respiratory care during the transport

Equipment Drug Monitoring

Oxygenation Sedatives Non-invasive blood pressure

Patient’s condition, reason

Details and status of vital

Clinical events during the

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